NHS Choices - Behind the Headlines

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Updated: 6 hours 52 min ago

Excess body fat now linked to 13 different types of cancer

Thu, 25/08/2016 - 18:30

"Experts have linked eight more cancers to being overweight or obese, nearly tripling the list from five to 13," the Daily Mail reports.

This is the latest finding of the International Agency for Research on Cancer (IARC), a group of cancer experts from around the world that look at risk factors for cancer. 

What is the basis for these reports?

The headlines are based on a report published in the peer-reviewed New England Journal of Medicine.

The report is not exactly new research, but a review of previously published studies that looked at the link between weight and cancers.

It is the result of a working group of international cancer researchers who met to review the evidence in April this year.

They reviewed studies in humans, animals and basic science to see whether the group's previous conclusions, published in 2002, needed to be updated.

The group's new report concludes that, "the absence of excess body fatness lowers the risk of most cancers", also saying that losing weight intentionally may help prevent cancer.

They list 13 cancers where they say there is "sufficient" evidence to conclude that being a healthy weight reduces the risk of cancer, three where there is "limited" evidence, and eight where the evidence is "inadequate".

The cancers they identify as having sufficient evidence to link them to weight are:

The degree of increased risk ranged from an almost fivefold increase for oesophageal cancer in the highest BMI category compared with people with a normal weight (relative risk [RR] 4.8; 95% confidence interval [CI] 3.0 to 7.7), to a 10% increased risk of postmenopausal breast cancer (RR 1.1, 95% CI 1.1 to 1.2).

What is the link between cancer and weight?

Scientists have known for some time that people who are overweight have an increased risk of certain cancers compared with people of a healthy weight.

A healthy weight is usually defined as having a body mass index (BMI) of 18.5 to 24.9. People are classed as overweight if their BMI is 25 to 29.9 and obese if their BMI is 30 or over. BMI is calculated from weight and height.

Almost all of the evidence linking being overweight and cancer is from epidemiological studies, which look at large groups of people and then calculate how likely people of different weights are to have been diagnosed with cancer, compared with people of a healthy weight.

Many of these studies also try to take account of other factors that can affect cancer risk, such as whether people smoke, whether they exercise, and how healthy their diet is.

But it's hard to account for all other factors, so individual studies can't really show whether being overweight causes cancer.

When reviewed together, however, and when studies show that the more overweight someone is, the more likely they are to get cancer, the chances are higher that the research is showing that weight has a causal effect.

A report by the IARC in 2002 said there was enough evidence to say being overweight increased the risk of eight cancers, all of which are included in the new list of 13.

Since then other studies have strengthened the evidence, so the IARC now feels it has enough evidence to list these 13 cancers.

How does weight and cancer affect you?

Carrying excess body weight has a number of health risks, including a greater chance of having a heart attack or stroke, as well as being linked to a raised risk of the cancers listed above.

The easiest way to keep to a healthy weight is to avoid putting weight on, but if you already weigh more than you like, diet and exercise can help you achieve a healthier weight.

Talk to your GP or see our 12-week plan to lose weight through healthy eating and physical activity.

Weight is not the only factor that affects the risk of cancer. Although there's no proven way to avoid cancer altogether, you can lower your risk of getting cancer if you:

Links To The Headlines

The big fat cancer curse: Scientists link obesity to thirteen types of disease including the ovaries, stomach and liver. Daily Mail, August 24 2016

Putting on weight can increase risk of 13 different cancers new study claims. Daily Mirror, August 24 2016

Fat cancer threat: obesity found to trigger 8 more types of cancer. The Sun, August 25 2016

Obesity is linked to more cancers. The Times, August 25 2016 (subscription required)

Links To Science

Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer — Viewpoint of the IARC Working Group. The New England Journal of Medicine. Published online August 25 2016

Categories: NHS Choices

Being sick of the daily commute could be affecting your health

Wed, 24/08/2016 - 17:40

"Why your commute is killing you: stressful rush-hour journeys are shortening commuters' lifespans," The Sun reports after the Royal Society for Public Health published a report arguing that commuting can negatively impact both physical and mental health.

The report highlights research that suggests non-active commuting – not walking or cycling to work – is detrimental to our health.

The research indicates it can increase how many unhealthy foods we eat, impact our mental health and raise blood pressure, among other things.

The issue of commuter health is arguably more important than ever because of the increasing number of people who have to commute.

As the report points out, there are now 24 million regular commuters in England and Wales, with the average commute lasting 56 minutes a day.

Not only does commuting increase snacking habits, it also means we have less free time available to lead an active, healthy lifestyle.

To combat this trend, the report calls for the public to cycle or walk to work where possible. They recommend employers adopt a flexible working policy to allow more people to work from home or travel to and from work at different times.

Transport companies are also called upon to increase healthier food options in stations, put on more trains, get rid of first class carriages to increase seating capacity, and advise travellers of train capacity to enable them to plan their journeys at less stressful times.

Who produced the report?

The report was produced by the Royal Society for Public Health (RSPH) in recognition of the substantial increase in the number of workers with long daily commutes to work.

The society is an independent charity dedicated to the improvement of public health and wellbeing.

In England and Wales 90% of the workforce commutes to work, spending an average of 56 minutes travelling, rising to 79 minutes in London.

The benefits of active travel, such as cycling and walking to work, are well known, yet the majority of commuters opt for passive travel, commuting by car, bus or train – often out of necessity rather than choice.

The report is not a systematic review, so there may have been evidence that contradicted its views that was overlooked. That said, it would be surprising if there was a large body of evidence outlining how rush hour commuting is good for us.

What evidence did they look at?

Evidence was gathered from a variety of sources, including the Office for National Statistics, examining wellbeing, length of commute and type of commute.

The British Household Panel Survey similarly looked at commuting information and measured self-reported health status.

Opinion polls were undertaken by the Royal Society for Public Health themselves, and The Work Foundation surveyed respondents on their work pattern preferences.

What were the main findings?

The main findings were that health status, level of happiness and satisfaction were lower for people who had longer commutes. These people were also more likely to go to their GP.

People who travel by bus or coach had lower levels of life satisfaction and less sense that their daily activities are worthwhile than those travelling by car, while those taking the train had higher levels of anxiety.

In a poll of 1,500 people, 55% said they felt more stressed as a result of their commute and 41% did less physical activity.

Commuters felt their journey contributed an average additional 767 calories – the equivalent of around three Big Macs – to their diet each week from food and drink outside regular meals, and 33% said they snacked more.

The factors impacting health the most were found to be:

  • length of commute
  • uncomfortable temperatures
  • anti-social behaviour
  • overcrowding
  • journey delays
What recommendations did the report make?

The report recommends that commuters engage in active travel where possible, enabling them to build physical activity into their daily routine.

One way of increasing the time workers spend on health-promoting activities is to move towards a flexible home working culture, away from the nine to five.

In recent years the number of organisations allowing employees to work from home has hugely increased, and it's estimated this will be the norm for more than half the workforce by 2017.

This trend needs to continue, says the report, as research shows it is beneficial for both the health and wellbeing of staff, as well as productivity.

But for some workers, flexible working may not be possible – for example, those who work in people-facing roles.

For those who still have to travel at rush hour, transport companies have a role to play in improving the health and wellbeing of their customers and decreasing stress, the report states.

The report says station design guidelines should introduce health and wellbeing as a key consideration for their retail and catering facilities. This could help cut down the extra calories consumed by commuters.

It advises that overcrowding must be tackled to minimise commuters' stress levels. The report recommends publishing crowding levels on train and bus services, empowering commuters to plan their journeys.

The report also calls for longer platforms and more frequent services. And it argues that first class carriages should be abolished, as these are often half empty while the rest of the train is full.

Conclusion

The report does make for interesting reading, especially as more of us are commuting than ever before.

There are steps you can take to factor in a DIY fitness programme as part of your daily routine:

  • Get off a bus or tube stop before your destination.
  • If you need to drive, try to park further away from your office and walk the rest of the way.
  • Discuss project ideas with a colleague while taking a walk.
  • Stand while talking on the telephone.
  • Walk over to someone's desk at work rather than calling them on the phone or sending an email.
  • Take the stairs instead of the lift, or get out of the lift a few floors early and use the stairs.
  • Walk up escalators or travelators rather than standing still.
  • Go for a walk during your lunch break – use a pedometer to keep track of how many steps you take.

And downloading some podcasts on to your smartphone ahead of time can keep you distracted during your commute, which may help reduce your stress levels.

Links To The Headlines

Why your commute is killing you: stressful rush-hour journeys are shortening commuters' lifespans. The Sun, August 24 2016

What's the downside of commuting? An extra 767 calories, report finds. The Daily Telegraph, August 24 2016

UK workers consume 800 extra calories a week while commuting. The Guardian, August 24 2016

Commuting adds 800 calories a week to our diet turning the rat race into the fat race. Mail Online, August 24 2016

Links To Science

Royal Society for Public Health. Health in a hurry. August 2016

Categories: NHS Choices

Childhood head injury linked to range of adult health problems

Wed, 24/08/2016 - 16:28

"Millions of Brits face dying early because of something they did when they were children," says the Daily Mirror's needlessly alarming headline.

The newspaper reports on a study which found that a head injury causing concussion (known as a traumatic brain injury or TBI) may increase the chances of a range of health problems in later life.

The study used Swedish databases to follow more than a million people for up to 41 years. Nine percent of them had been treated in hospital for a TBI before they were 25.

After adjusting their figures to account for family circumstances, the researchers found those who'd had a head injury were slightly more likely to:

  • be receiving a disability pension
  • have been treated for psychiatric illness
  • not have secondary school qualifications
  • have died before the age of 41

Older children, those with more severe head injuries, and those who had more than one head injury were more likely to be affected.

The study doesn't prove that the head injuries caused the problems.

It's possible that factors the researchers didn't measure had an effect. For example, children with behavioural problems may be both prone to childhood accidents as well as more likely to experience difficulties in adulthood.

When it comes to head injuries, prevention is better than any cure. But it is also important not to discourage your child from taking part in physical activity, as this brings a much greater risk of health problems in adulthood.

 

Where did the story come from?

The study was carried out by researchers from Oxford University, Imperial College London, Indiana University, and the Karolinska Institute in Sweden. It was funded by the Wellcome Trust, the Swedish Research Council and National Institute for Child Health and Human Development.

The study was published in the peer-reviewed journal PLOS Medicine on an open-access basis, so it is free to read online.

The Times, Mirror and Daily Mail headlines all focused on the increased risk of early death after childhood concussion, although this outcome had the lowest absolute risk of all those studied. The researchers analysed their figures three ways, with different levels of accounting for confounding factors, including family circumstances. Perhaps unsurprisingly, the newspapers used the figures which showed the biggest increase in risk, not the ones that took full account of this confounding.

However, the newspapers did quote experts who cautioned there is a need to balance the risks of injury from sports such as rugby and football against the benefits of taking part in sport. The Mirror's extrapolation that "millions of Britons" are at risk of early death seems a bit over-done, although up to 700,000 children are apparently treated for head injury in the UK each year.

 

What kind of research was this?

This was a cohort study, using a national database of births in Sweden. These studies are good ways to find links between factors, in this case head injury in childhood or early adulthood, and a range of outcomes including poor educational achievement, inability to work on health grounds, and early death. However, they cannot prove that one causes the other.

 

What did the research involve?

Researchers followed up 1,143,470 people born between 1973 and 1985 in Sweden. They used Sweden's database system to check whether they'd been treated for a brain injury that caused concussion, before the age of 25. They then looked at a range of outcomes in adulthood, including poor educational achievement and early death. After adjusting their figures to take account of people's family circumstances, they looked to see whether people who'd had a head injury were more likely to have one of these outcomes.

Family circumstances, including deprivation, parental education level and environment, can affect both the chances of having a head injury and the chances of one of the long-term outcomes being measured. Therefore the researchers also looked at what happened to the brothers or sisters of children with head injury, to see whether they were more or less likely to have had one of these outcomes.

They calculated the risk of the outcomes for people with and without head injury in early life using three models. First they just adjusted for sex, year of birth and order in which children were born. In the second model they also adjusted for family circumstances such as income and parental education. Finally, they performed further adjustments to take account of what happened to siblings of children with head injuries. The figures we report in the results section below are the third set of figures, as they are likely to be the least affected by confounding factors.

Researchers also calculated the absolute risks of the different outcomes, and looked at the effects of the severity of injury, age of injury and repeated injury. 

 

What were the basic results?

Of more than a million people studied, 104,290 (9.1%) had been treated for a head injury. Looking at the people injured compared to 55,831 siblings who had not had head injuries:

  • 6.3% received a disability pension, compared to 5.5% of unaffected siblings
  • 20% had an outpatient psychiatric visit (10.4% were admitted to psychiatric hospital), compared to 18.4% of unaffected siblings (9% were admitted to psychiatric hospital)
  • 1.6% had died before age 41, compared to 1.4% of unaffected siblings
  • 13.9% didn't pass secondary school qualifications, compared to 12.5% of unaffected siblings

These figures translate into increased relative risks which look high, though the overall difference between people with and without head injury is small, as shown above. For each outcome, the results are:

  • 49% increased risk of disability pension (relative risk (RR) 1.49, 95% confidence interval (CI) 1.38 to 1.6)
  • 31% increased risk of outpatient psychiatric visit (RR 1.31, 95% CI 1.26 to 1.37)
  • 57% increased risk of admission to psychiatric hospital (RR 1.57, 95% CI 1.47 to 1.67)
  • 40% increased risk of death before age 41 (95% CI 1.16 to 1.68)
  • 28% increased risk of low educational achievement (95% CI 1.23 to 1.33)

In addition, the results showed that having a severe head injury increased the risk of any of these outcomes, as did having more than one head injury.

 

How did the researchers interpret the results?

The researchers say their results "indicate potentially causal effects" between head injury in childhood and problems later in life. They say this implies a need to prevent head injury, through better parental supervision of young children and prevention of sports-related concussion for older children. This "could focus on changes to rules so that risks of players colliding their heads with each other or with equipment", including heading footballs, is reduced, they say.

Less controversially, they call for age-appropriate follow-up of children who've had head injuries, to try to prevent them from falling behind at school, and to take action on signs of health or social problems.

 

Conclusion

This is an important study, but the more alarming headlines over-state the absolute risks of problems in adulthood following on from a childhood head injury. The majority of people who'd had a head injury didn't have any of the problems studied, and the overall risk of death by age 41 – the outcome that got most press attention – was 1.6% – only 0.2 percentage points higher than for the unaffected siblings of children with head injury.

The study has a number of strengths:

  • it is very large
  • has a long follow-up period
  • the Swedish database records are thought to be accurate
  • it includes figures about siblings of children with head injury, helping to account for some of the differences seen with family upbringing, although they can't account for everything

Some experts questioned whether neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) might increase both the risk of head injury and of the adverse outcomes in adulthood. However, the researchers say they took account of psychiatric and neurological conditions that occurred before age 25, and that this did not affect the results.

As various experts have warned, the risk of head injury should not be used as a reason for children not to take part in activities such as sports. We don't know from the study whether the injuries were sports-related, and we do know that physical activity has many benefits, including in the fight against childhood obesity.

Perhaps the most important conclusion from the study is that children and young people who've had a concussion should be monitored for signs of problems later in life, so that they can be helped to avoid some of the potential consequences.  

Links To The Headlines

Childhood concussion warning: Even a minor bang to the head can raise the risk of an early death. Daily Mail, August 24 2016

Millions of Brits face dying early because of something they did when they were children. Daily Mirror, August 24 2016

Child head injuries linked to early death. The Times, August 24 2019 (subscription required)

Links To Science

Sariaslan A, Sharp DJ, D’Onofrio BM, et al. Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes. PLOS Medicine. Published online August 23 2016

Categories: NHS Choices

Combined HRT breast cancer risk 'may have been underestimated'

Tue, 23/08/2016 - 16:28

"Women who take a common form of HRT are nearly three times as likely to get breast cancer, a major study has found," the Daily Mail reports.

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause, such as hot flushes. It replaces hormones that typically drop to a lower level during the menopause.

A landmark study in 2001 first linked HRT to an increased risk of breast cancer. But exactly how much of an increase has since been a matter of debate.

Some critics argue the risk was overstated, leading to a "'wasted decade' of suffering since the HRT scare", as we discussed in 2012.

This study aimed to better quantify the size of the risk with the different HRT types by looking at questionnaire data from around 40,000 women in the UK.

Researchers found women taking combined HRT – both oestrogen and progestogen – had just over twice the risk of developing breast cancer compared with women who have never taken HRT.

Women who took the pill for 15 years or more had three times the risk – though this was only seven women in total, meaning the link may have been subject to chance.

Reassuringly, the risk returned to baseline around a year or two after a woman had stopped taking HRT.

Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, advised: "Some women will feel HRT to be a necessity. But in order to minimise the risk of breast cancer … it is recommended that the lowest effective dose is used for the shortest possible time."

Where did the story come from?

The study was carried out by researchers from the Institute of Cancer Research and the National Cancer Registration Service, Public Health England, both in the UK.

It was funded by Breast Cancer Now, the Institute of Cancer Research and the Royal Marsden/ICR NIHR Biomedical Research Centre.

The study was published in the peer-reviewed scientific journal British Journal of Cancer. It is available on an open access basis and is free to read online.

The authors declared no conflict of interest.

The UK media's reporting was accurate, acknowledging that it is only the combined oestrogen and progesterone pill that has demonstrated these findings.

The Mail should be given credit for being one of the few sources that made an attempt to put the estimated rise in risk in context.

Headlines stating that the combined HRT "triples the risk of breast cancer", as The Times put it, don't actually provide much useful information unless you know what the initial risk is.

The Mail helpfully summarised the results, saying: "According to the new estimates, 34 women in 1,000 would get breast cancer on combined HRT, an extra 20 than among the group who does not take the drugs." 

What kind of research was this?

This was a prospective cohort study of 39,183 women taking part in the Breakthrough Generations Study, which has ascertained hormone replacement therapy use and menopausal status.

The link between HRT and breast cancer is already recognised. It has also already been observed that most cases have tended to occur in women taking combined HRT.

Women who still have a womb usually need to take oestrogen combined with a progestogen, as oestrogen alone may increase the risk of womb cancer.

Prospective cohort studies, particularly of this size and length, can be useful ways to demonstrate the link between drug use and risk on health outcomes.

However, observational studies cannot prove that one factor – in this case, the combined HRT pill – directly causes another – breast cancer – because other factors may be involved.

For example, obesity, family history and alcohol consumption are all known to be linked to breast cancer risk.

What did the research involve?

Researchers used data from a large questionnaire-based study that took place between 2003 and 2015. Assessments were made at recruitment, after 2.5 years and again at six years.

Breast and other cancers were identified from recruitment and follow-up questionnaires, and spontaneous reports to the centre. Diagnoses were confirmed by looking at cancer registries in the UK and accessing the women's medical records.

Women were only included if they had no previous history of breast cancer. The researchers also excluded women who had had a hysterectomy.

Information on HRT use was obtained at recruitment and in follow-up questionnaires. Women were asked the ages they started and stopped use and the name of the drug.

Analysis of HRT use was from when women had been taking the pill for at least a year and continued for a year after they stopped taking it, as this was considered the time women were exposed to the drug.

The researchers took into account a range of confounding variables that may be associated with breast cancer risk.

These included:

  • family history of breast cancer in first-degree relatives
  • socioeconomic status
  • age at first pregnancy
  • number of children
  • alcohol consumption
  • duration of breastfeeding
  • pre- and post-menopausal body mass index (BMI)
What were the basic results?

Over the course of the six-year follow-up, 775 (2%) of the total 39,183 women in the study developed breast cancer.

Among current users of HRT, there were reported to be 52 cases among women taking combined HRT, 23 in women taking oestrogen only, and 15 among women taking other or unknown HRT.

This calculated to a more than doubled increased risk of breast cancer in women taking combined HRT for 5.4 years on average, compared with those with no previous HRT use (hazard ratio [HR] 2.74, 95% confidence interval [CI] 2.05 to 3.65).

For more than 15 years of combined HRT, the hazard ratio increased to 3.27 (95% CI 1.53 to 6.99) compared with no HRT use.

There was no increased risk for oestrogen-only HRT (HR 1.00, 95% CI 0.66 to 1.54). However, there was an increased risk for any type of HRT not specified by type (HR 1.95, 95% CI 1.55 to 2.46).

How did the researchers interpret the results?

The authors concluded that, "Our results show that risk of breast cancer increases with duration of use of combined MHT up to ≥15 years, and relative risks in most of the published literature are likely to be substantially underestimated.

"These results provide further information to allow women to make informed decisions about the potential risks and benefits." 

Conclusion

This study shows a link between the use of combined oestrogen and progesterone HRT and breast cancer risk, particularly among women who take the pill for a long period of time. But this is not the entire story.

The study included a large cohort of women. The risk increase for combined HRT is based on only 52 of the 39,183 women taking the combined pill who developed breast cancer.

Of these, only seven women had been taking the pill for more than 15 years. Therefore, the analysis was based on a very small number, which may mean the risk associations are not completely accurate.

Assessments were based on self-report questionnaires, so there is a possibility of recall bias. For example, some information about use of HRT pills was collected from women after their breast cancer diagnosis. As the combined HRT pill has been linked to breast cancer, women may have recalled their use differently from those who didn't develop cancer.

Although the researchers took into account a wide range of factors, it's possible that some unaccounted factors influenced the link. One of these factors the authors note is BMI, which should be taken into consideration, particularly when comparing results between studies.

These findings will be of concern to women taking combination HRT. But there are a few extra points to put this into perspective.

The baseline risk of developing breast cancer with combined HRT is still quite small. This research found no link with the oestrogen-only pill.

But we still can't conclude with complete certainty that it's only the combined pill that carries a breast cancer risk – particularly when the analyses combining all types of HRT found an increased risk. For now, it has to be considered that any type of HRT could carry a small increased risk of breast cancer.

HRT can also increase the risk of developing other types of cancer. Oestrogen-only HRT can increase the risk of womb cancer and is normally only used in women who've had a hysterectomy – women who were excluded from this study.

This means we cannot conclude that all women taking combined HRT should switch to oestrogen-only – they could be increasing their risk of another type of cancer.

Other potential risks of HRT include ovarian cancer and blood clots. Whether or not the benefits outweigh the risks therefore has to be considered on an individual basis.

The authors call for women to be provided with more information to make informed decisions about the potential risks and benefits of HRT overall, and by the specific type: combined or oestrogen-only.

There is no one-size-fits-all recommendation when it comes to whether a woman should take HRT. Your GP should be able to provide more detailed information about your own individual circumstances.  

Links To The Headlines

Women who take a common form of HRT are 'nearly THREE times as likely to get breast cancer'. Daily Mail, August 23 2016

HRT triples the risk of breast cancer, biggest ever study shows. The Daily Telegraph, August 23 2016

British study finds combined HRT nearly triples risk of breast cancer. The Guardian, August 23 2016

Hormone Replacement Therapy TREBLES the risk of women developing breast cancer. Daily Mirror, August 23 2016

Taking HRT 'triples risk of breast cancer'. ITV News, August 23 2016

HRT can triple risk of breast cancer. The Times, August 23 2016 (subscription required)

Links To Science

Jones ME, Schoemaker MJ, Wright L, et al. Menopausal hormone therapy and breast cancer: what is the true size of the increased risk? British Journal of Cancer. Published online July 28 2016

Categories: NHS Choices

Gene scanning 'could improve screening for oesophageal cancer'

Mon, 22/08/2016 - 17:20

"Simple test can now reveal which heartburn patients are at risk of oesophageal cancer," is the hopeful headline in the Daily Mail, reporting on a new study from researchers at Queen Mary University of London.

The researchers have been investigating whether a test for patients with Barrett's oesophagus may be able to predict the likelihood of the condition progressing to oesophageal cancer.

Barrett's is linked to gastro-oesophageal reflux disease (GORD), where acid leaks from the stomach back up into the throat. Stomach acid can aggravate the cells, so there is the potential for this condition to turn cancerous.

It's hard to precisely estimate cancer risk with this condition, however. The current thinking is around 1 in 10 people with GORD will develop Barrett's. Out of these people, around 1 in every 10 to 20 people will go on to develop oesophageal cancer.

So while the overall risk is small, it can still be distressing because of the uncertainty of outcome for people with Barrett's.

This latest research involved taking oesophageal cell samples from a sample of patients with Barrett's about three years apart to look at what factors predicted progression.

The researchers found progression was mostly linked to the degree of genetic diversity in the cells. Or, in the words of the lead researchers, some cells were just "born to be bad".

The follow-up time in this study is short, and it's not clear whether other risk factors were accounted for in the analysis or whether there are steps people can take to reduce their risk of cancer.

No doubt further larger studies of this technique are now being planned. 

Where did the story come from?

The study was carried out by researchers from a number of institutions, including Queen Mary University of London and the University of Amsterdam.

Funding was supported by the Dutch Cancer Foundation, the Netherlands Organization for Scientific Research, Fonds NutsOhra, the European Research Council, the Gut Club Foundation, and Abbott Molecular.

It was published in the peer-reviewed Nature Communications on an open access basis, so it is free to read online.

The Mail's reporting was accurate, providing information on oesophageal cancer, risk factors for the disease, and a description of Barrett's oesophagus. 

What kind of research was this?

This prospective cohort study aimed to assess whether a test performed on patients with non-cancerous Barrett's oesophagus may be able to predict whether the condition will progress to oesophageal cancer. 

Barrett's oesophagus is a condition where damage from the stomach acid eventually causes the cells in the lining of the oesophagus to change abnormally. It is often caused by acid reflux.

The abnormal cells are at an increased risk of becoming cancerous in the future, although this risk remains small. It's estimated 1 in every 10 to 20 people with Barrett's oesophagus will develop cancer within 10 to 20 years.

This type of study is useful for investigating links with factors that may be associated with cancerous change.

What did the research involve?

The researchers recruited adult patients with Barrett's oesophagus from an academic medical centre and six hospitals in The Netherlands.

Participants had to be aged 18 years or over and have endoscopy evidence of Barrett's oesophagus and no features of active oesophageal cancer.

All patients that developed cancerous change or oesophageal cancer within six months from the initial endoscopy were excluded from the study.

Endoscopic examinations with cell biopsy were carried out at the start of the study and then about every two to three years.

The researchers carried out laboratory tests on the biopsy samples to identify potential genetic markers and other disease features associated with progression. 

What were the basic results?

A total of 320 people with Barrett's oesophagus were included in the study, and were followed for an average period of 43 months.

During this time 20 (6.3%) people progressed, while eight people developed high-grade cancerous change and 12 developed oesophageal cancer.

The researchers found participants with little genetic diversity in their cell samples were unlikely to progress to cancer.

However, the opposite is true when genetic diversity is present. The researchers claim some cells are "born to be bad".

How did the researchers interpret the results?

The researchers concluded that genetic diversity correlates with the risk of Barrett's oesophagus progressing to cancer.

They say the level of genetic diversity over time does not appear to have an effect on the risk of progression to cancer – it seems to be  predetermined by the baseline level of diversity.

Conclusion

This prospective cohort study aimed to see whether a test performed on patients with non-cancerous Barrett's oesophagus may be able to predict whether the condition progressed to oesophageal cancer. 

Overall, they found genetic diversity in the oesophageal cell samples at the start of the study seemed to be linked to the risk of cancer progression.

However, the research has limitations to consider:

  • By design, this study is only able to draw links – it does not propose treatment or lifestyle steps to be taken to reduce risk.
  • The sample of patients in this study is small, so we cannot rule out that any associations seen are down to chance.
  • The length of follow-up it not sufficiently long to see how many of the participants went on to develop cancer, as this can take 10 to 20 years.
  • It is unclear whether the researchers have taken into account other risk factors for oesophageal cancer, such as smoking, drinking too much alcohol over a long period of time, being overweight or obese, and having an unhealthy diet.

The future aim of such a test could be to reduce the need for regular monitoring in patients at low risk of going on to develop cancer. But more research is needed to confirm the use of such a test.

The exact cause of oesophageal cancer is unknown, but stopping smoking, cutting down on alcohollosing weight and having a healthy diet may all help reduce your risk.

Links To The Headlines

Simple test can now reveal which heartburn patients are at risk of oesophageal cancer. Mail Online, August 19 2016

Links To Science

Martinez P, Timmer MR, Lau CT, et al. Dynamic clonal equilibrium and predetermined cancer risk in Barrett's oesophagus. Nature Communications. Published online August 19 2016

Categories: NHS Choices

Animal research suggests Zika could affect the adult brain

Fri, 19/08/2016 - 16:30

"Zika virus may cause long-term memory damage, similar to Alzheimer's disease," The Daily Telegraph reports. At the moment such a claim is pure speculation as it is based on research into mice.

Currently, the effects of the Zika virus are thought to be short-term in adults, only presenting a threat to unborn babies. The short-term symptoms in adults are usually similar to the flu, such as fever and joint pain.

This latest research involved mice bred to have an immune deficiency to the Zika virus. Researchers found that after injecting the virus into their blood, it went on to have an effect on areas of the brain where new brain cells are created. If a similar effect occurred in humans there could be a potential impact on memory and thinking skills.

The last major Zika outbreak occurred in French Polynesia in 2013-2014. During this time the World Health Organization recorded an increase in the number of cases of Guillain-Barre syndrome (GBS); usually a rare neurological condition that can cause muscle weakness due to nerve damage. But the picture was complicated as the area was also in the grip of a dengue outbreak, which has also been associated with GBS.

As this was exploratory research, we don't yet know the implications of these findings for adults. The picture may become clearer once more data is analysed from the ongoing outbreak in the Americas.

If travelling to Zika-affected areas, then following standard advice about avoiding mosquito bites would be wise.  

Where did the story come from?

The study was carried out by researchers from the Howard Hughes Medical Institute, the University of California and the La Jolla Institute for Genomic Medicine, all in the US. It was funded by the National Institutes of Health, the Simons Foundation of Autism Research Initiative and the Howard Hughes Medical Institute. There appear to be no conflicts of interest.

The study was published in the peer-reviewed medical journal Cell Stem Cell on an open-access basis, which means you can read it for free online or download it as a PDF.

The UK media generally reported it accurately and, refreshingly, made clear from the start that this was animal research. Though as is so often the case, many headlines were needlessly alarmist, such as the Mail Online's choice of language about the virus possibly "devastating" human brains.

 

What kind of research was this?

This animal study in mice aimed to look at the effects of infection with Zika virus on the brains of adult mice.

Recent global attention has been drawn to the Zika virus outbreak and its link with cases of microcephaly, when the brain does not develop properly in babies. It has also been linked to Guillain-Barre syndrome, when the body's immune system attacks part of the peripheral nervous system.

Until now, the virus was thought only to affect pregnant women's babies, not the rest of the adult population. Short term symptoms experienced by some adults include a fever, rash, joint pain, headaches and vomiting.

Although Zika is considered a short-term infection in adult humans, the long-term effects on the adult brain have yet to be studied.

Animal studies are often used in the early stages of research to see how biological processes may happen in humans. However, we are not identical to animals and the implications for humans may need to be tested in other ways, especially to see if humans can develop immunity to the virus quickly.

 

What did the research involve?

This was complex laboratory research using mice to observe the effect of Zika virus on adult brain cells.

Mice were bred with immune deficiencies. At between five and six weeks old, researchers infected the mice with an Asian strain of the Zika virus.

Mice were injected in a way that introduced the virus into the bloodstream rather than directly into in the brain, to mimic the way the virus enters the bloodstream in humans.

To examine the potential for viral infection in the brain, the researchers screened sections of the brain from both infected mice and mock-treated mice.

The impact on brain cell division and loss was assessed using cell cycle markers. These are essentially fluorescent tags that allow the researchers to track how the virus spread through brain cells.

 

What were the basic results?

The researchers found that Zika virus was concentrated in the two sections of the brain where there is active cell division in adult mice. These were the subventricular zone (SVZ) of the anterior forebrain and the subgranular zone (SGZ) of the hippocampus. These are both areas of the brain where new brain cells are produced (neurogenesis).

The researchers found that when the Zika virus entered the bloodstream of the mice, there was pronounced evidence of Zika infection in these two brain areas, which led to cell death and reduced cell division.

The changes were found in the three mice infected with the Zika virus and not in the three mice who weren't infected.

The results suggested an increase in the death of neural cells in these two areas. The areas of the brain that were not associated with cell division were not affected by the virus.

 

How did the researchers interpret the results?

The researchers concluded that "the virus was able to infect SVZ and SGZ niche cells to a much greater degree than non-neurogenic regions."

They also "recognize that healthy humans may be able to mount an effective antiviral response and prevent entry into the CNS, but it remains a possibility that some immunocompromised humans and even some apparently healthy humans may be susceptible in ways modeled by the TKO mice [mice where certain immune cells had been 'knocked out']".

 

Conclusion

This experimental study in mice investigated the effect of Zika virus on adult brain cells, hoping to increase knowledge of the long-term outcomes of Zika virus on the adult brain. Zika was thought to be a short-term virus for adult humans without many long-term effects.

The researchers' experiments in mice found that the two small areas in the adult mouse brain containing cells active in cell division can be susceptible to pronounced Zika infection leading to cell death and reduced cell division.

While healthy humans may be able to mount an effective immune response to the virus, it is possible that immunocompromised humans may be susceptible in ways demonstrated by the mice.

However, as the authors point out, the study only used a single virus strain, a single mouse strain and was at a single point in time. There is more information needed before the implications for humans are understood.

Future studies are needed in infected humans to describe the effects of the Zika virus on the adult brain.

Public Health England provide an up-to-date overview of the current state of the Zika virus outbreaks in the Americas, as well as specific advice for certain groups, such as pregnant women or women planning to become pregnant.

Links To The Headlines

Zika virus may cause long-term memory damage, similar to Alzheimer's disease. The Daily Telegraph, August 18 2016

Could Zika devastate the brain like Alzheimer's? Virus attacks the area linked to learning and memory. Daily Mail, August 18 2016

ZIKA ALZ DANGER Zika virus can cause similar brain damage to Alzheimer's in adults, study finds. The Sun, August 19 2016

Links To Science

Li H, Saucedo-Cuevas L, Regla-Nava JA, et al. Zika Virus Infects Neural Progenitors in the Adult Mouse Brain and Alters Proliferation. Cell Stem Cell. Published online August 18 2016

Categories: NHS Choices

Perfect painkiller? Safe alternative to opiates may have been found

Fri, 19/08/2016 - 13:00

The Independent has claimed: "Scientists discover what could be a 'perfect' painkiller without side effects".

Opiate-based painkillers such as morphine are extremely effective in relieving pain. The problem is that they are also addictive if taken on a medium- to long-term basis. Also morphine, if taken at high dosage, can cause potentially fatal breathing difficulties (respiratory depression).

New research suggests that a newly identified compound, PZM21, could be more effective at longer-lasting pain relief than morphine, without any of the attendant drawbacks.

The compound caused less activation of the brain's reward system compared to morphine, indicating that it may be less addictive. And when tested in mice it also resulted in less respiratory depression and constipation than morphine.

However, this was an early-stage laboratory study in mice. We don't know that this provides the whole answer, and findings would need to be replicated in humans.

It is also important to stress that when taking painkillers, more doesn't mean better. It can be extremely dangerous to take more than your recommended dose. This applies not only to prescription painkillers, but over-the-counter products such as paracetamol.

 

Where did the story come from?

The study was carried out by researchers from Stanford University School of Medicine, the University of California, UNC Chapel Hill Medical School – all in the US – and the Friedrich-Alexander-Universitat Erlangen-Nurnberg and the Paracelsus Medical University in Germany. It was funded by the US National Institutes of Health grants.

The study was published in the peer-reviewed medical journal Nature.

There may be a conflict of interest as several of the authors have filed a provisional patent on PZM21 and related molecules. Several are also consultants and co-founders of Epiodyne, a company seeking to develop new analgesics. Though these sort of links with industry, when it comes to researching drugs, are nothing out of the ordinary.

The UK media's reporting was generally accurate; with The Independent acknowledging the limitations of the drug as it "shows 'promise' as a replacement for opium-based drugs such as morphine – although it has only been tested in mice so far".

 

What kind of research was this?

This was an animal study that aimed to identify a new compound that could act as a more effective painkiller than morphine.

Morphine is an alkaloid from the opium poppy that is used to treat pain. Although the natural products morphine, codeine, and the semi-synthetic drug heroin, are more reliably effective at providing pain relief than raw opium, they have potentially lethal side effects. These include respiratory depression and constipation. Current opioid painkillers also have the negative side effect of being addictive.

Animal studies are often used in early stages of research to see how biological mechanisms may work in humans. However, humans are not identical to animals and there are many stages of development from animal-based studies to developing treatments for humans.

 

What did the research involve?

This was complex laboratory research that measured the painkilling properties of a new compound called PZM21 on mice. This compound is thought to work further down the painkilling pathway than morphine, so it was hoped that it would have fewer undesirable side effects.

The researchers compared PZM21 with morphine, another compound called TRV130 and placebo. They looked at the strength of pain relief, how long it lasted and whether it acted on the addiction centres in the brain. They also measured any effect on the breathing rate and constipation.

 

What were the basic results?

Pain relief from PZM21 lasted longer than morphine. The effectiveness and length of pain relief was assessed by seeing how well (or not) the mice tolerated exposure to heat.

It was found to last up to 180 minutes in mice. It was 40% effective at this time point compared to 5% for morphine. At 120 minutes, PZM21 was still able to exert 60% pain relief compared to 15% for morphine.

PZM21 caused less activation of reward pathways compared to morphine. This was assessed by studying how the mice moved. Rodents that are "high" tend to run round at great speed (which is known as an acute hyperlocomotive response).

PZM21 did not reduce the breathing rate compared to placebo. The rate during the injection for all of the mice was high at around 400 breaths per minute (normal is around 80 to 230). Morphine caused it to reduce to around 150 breaths per minute, while PZM21 and placebo reduced it to around 250 breaths per minute.

PZM21 caused less constipation than morphine.

 

How did the researchers interpret the results?

The researchers concluded that: "The structure-based approach led to a compound with novel properties; it was structurally distinct compared to previously explored opioid ligands, with not only substantial signalling bias but also with unexpected opioid receptor selectivity.

"These features have contributed to favourable biological effects, with long-lasting analgesia coupled to apparent elimination of respiratory depression, specificity for central over reflex analgesia, lack of locomotor potentiation and conditioned place preference, and hence a reduced potential for opioid-induced reinforcement for PZM21 and molecules like it."

 

Conclusion

This experimental study identified a new compound, PZM21, and investigated its effectiveness and safety in mice compared to morphine and TRV130. This research hopes to aid the development of an effective alternative to morphine that has none of the drawbacks, such as respiratory depression, constipation and addiction.

The researchers' experiments in mice found that PZM21 was more effective as a longer-lasting painkiller than morphine and that, at equal painkilling doses, had hardly any effect on respiratory depression, unlike morphine. They also found that compared to morphine, the constipating effect was reduced and the compound did not activate the dopaminergic reward system, a mediator of addiction.

This research helps take us one step closer to developing effective painkillers that are without the potentially lethal side effects of morphine. But this was an early stage experiment in mice. We don't know that this drug will provide the answer and findings will need to be confirmed in human studies.

While these findings may drive future drug research, it is unclear how long this process may take. 

Links To The Headlines

Scientists discover what could be a 'perfect' painkiller without side effects. The Independent, August 17 2016

An end to morphine? New drug could provide safer painkiller alternative amid opioid epidemic. Mail Online, August 17 2016

AN END TO MORPHINE? Boffins develop 'promising' new painkiller that is safer than morphine. The Sun, August 17 2016

Links To Science

Manglik A, Lin H, Aryal DK, et al. Structure-based discovery of opioid analgesics with reduced side effects. Nature. Published online August 16 2016

Categories: NHS Choices

Calcium supplements linked to post-stroke dementia in women

Thu, 18/08/2016 - 15:30

"Calcium supplements could dramatically raise the risk of dementia in women who suffer a stroke, a new study found," the Mail Online reports. However, the sample size (98) of women taking supplements was small, which casts doubts on the reliability of the claims.
 
The Swedish study included 700 women aged over 70 without dementia, 98 of whom were taking calcium supplements (we assume due to concerns about osteoporosis, though this was not discussed in the study). After five years, 14.3% of women who'd taken supplements had developed dementia, compared to 7.5% of women who didn't – about double the risk, after taking other factors into account.

Further analysis showed that the raised risk only applied to women who had already had a stroke, or who had signs of damage to blood vessels in their brain on scans. However, this was based on just six out of 15 women with a history of stroke and 50 out of 316 with signs of blood vessel damage who had taken calcium supplements.

The researchers say that because their study is "relatively small" and an observational study, their findings need to be confirmed. They don't call for any immediate action as a result of their findings.

It is possible to increase calcium levels through diet alone. Foods such as dairy products, green leafy vegetables, soya beans and nuts are good sources of calcium. Read more about ways to improve bone health.

 

Where did the story come from?

The study was carried out by researchers from the University of Gothenburg in Sweden and University College London, and was funded by grants from many different organisations, including the Swedish Research Council. The study was published in the peer-reviewed journal Neurology.

The coverage in the UK media was at times alarmist. While the Daily Telegraph took a more measured approach, the Mail's headline goes as far as telling people who've had a stroke to avoid calcium supplements; something that the researchers do not do.

Both reports made clear the distinction between calcium in foods such as milk and green leafy vegetables – which is not thought to have risks – and calcium supplements. However, neither reported the small number of women on which the main results were based. 

 

What kind of research was this?

This was a population-based cohort study, which followed a group of women over time. Cohort studies are good at showing links between factors (in this case, calcium supplements and dementia) over time. On their own they cannot show that one factor causes another and may be subject to other confounding factors, where other unmeasured risk factors may be contributing to the effect seen. 

 

What did the research involve?

Researchers followed 700 women from a larger population study in Sweden, all of whom were aged 70 to 92 and free of dementia at the start of the study. They were tested for dementia, and some had brain scans to look for signs of cerebrovascular disease (which includes stroke and so-called white matter lesions, areas of the brain which have poor blood flow), which is associated with vascular dementia. They were asked about use of medicines and supplements, including calcium. They were tested again for dementia five years later.

CT scans were used to look for brain lesions in 447 of the women at the start of the study, but were not repeated at the end. The women were tested using standard diagnostic criteria for dementia, by psychiatric nurses. Of the 700 women at the start of the study, 64 died and 105 did not take part in the follow-up. Nine of these women had dementia diagnoses in the Swedish Hospital Discharge Registry, so were included in the follow-up data.

The researchers analysed their data in a number of ways. They looked first at risk of any type of dementia for all women who'd taken calcium supplements, and then at particular types of dementia. Alzheimer's disease is the best-known type of dementia, but vascular dementia, caused by a series of mini-strokes, is also common. Some people have signs of both Alzheimer's and vascular dementia.

Researchers grouped together vascular dementia and mixed dementia into one group of stroke-related dementia. They also looked at risks for different groups of women: those who'd had a stroke, those whose CT scans showed white matter lesions, and those with no signs of cerebrovascular disease. They adjusted their figures to take account of confounding factors likely to affect dementia risk, including age, education, hormone use and genes known to influence Alzheimer's disease.

 

What were the basic results?

Of the 700 women in the study, 59 developed dementia. Overall, women who took calcium supplements were twice as likely to develop dementia as those who did not (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.01 to 4.37). This risk was more pronounced for stroke-related dementia (OR 4.4, 95% CI 1.54 to 12.61).

Importantly, closer analysis of the figures showed that taking calcium did not increase risk of dementia for women who'd not had a stroke or who had no signs of white matter lesions on their brain scans. For women who'd had a stroke, taking calcium supplements was linked to an almost seven-fold increase in the chances of getting dementia, but this was based on six women who took supplements out of 15 who had a stroke (OR 6.77, 95% CI 1.36 to 33.75). There was an almost three-fold increase in risk of dementia for women with white matter lesions, based on 50 of 266 women taking supplements (OR 2.99, 96% CI 1.28 to 6.96).

 

How did the researchers interpret the results?

The researchers were cautious in their conclusions, saying: "Calcium supplementation may increase the risk of developing dementia in elderly women with cerebrovascular disease." However, they added: "Because our sample was relatively small and the study was observational, these findings need to be confirmed."

 

Conclusion

The media paint this as a troubling study for older women who take calcium to strengthen their bones. However the small size of the study (only 98 women took calcium supplements, and only 14 of those got dementia) and its observational nature mean that we cannot rely on the results.

As the researchers mention, it is possible that those taking supplements were less healthy than those that didn't in some unmeasured way. Further research may improve our confidence in these results.

Broken bones are not a trivial matter for older people – a broken hip can be the difference between being able to live independently and needing to go into a nursing home.

Questions were raised last year, as we discussed at the time, about how well calcium supplements work to reduce the risk of broken bones, when two studies published in the BMJ showed they may not provide much protection for most people. However, these studies mostly looked at healthy adults aged 50 and over, not people being treated for weak bones.

The UK government currently recommends getting 700mg of calcium daily, and says a healthy, varied diet is likely to provide this for most people.

Good sources of calcium include:

  • milk, cheese and other dairy foods
  • green leafy vegetables – such as broccoli, cabbage and okra, but not spinach
  • soya beans
  • tofu
  • soya drinks with added calcium
  • nuts
  • bread and anything made with fortified flour
  • fish where you eat the bones – such as sardines and pilchards

If you need higher levels of calcium, you might need to take supplements, but it is best to talk to your GP first. 

Links To The Headlines

Calcium supplements increasing dementia risk for stroke survivors, new science suggests. The Daily Telegraph, August 17 2016

Have you had a stroke? Avoid calcium supplements if you want to escape the peril of dementia. Daily Mail, August 18 2016

BONE PILL RISK Pills taken to boost bone strength could raise risk of dementia, say boffins. The Sun, August 17 2016

Links To Science

Kern J, Kern S, Blennow K, et al. Calcium supplementation and risk of dementia in women with cerebrovascular disease. Neurology. Published online August 17 2016

Categories: NHS Choices

Women's cancer risk may increase the longer they're obese

Wed, 17/08/2016 - 18:00

"Fat women who refuse to diet 'are more likely to get cancer'," states the Mail Online, using a headline that is both inaccurate and offensive.

The study it reports on looked at the relationship between weight during adulthood, and cancer risk.

The researchers found that duration of time spent overweight or obese, as well as the degree, seems to have a compounding effect on cancer risk. But they did not look at whether the women in the study were asked to lose weight by dieting.

This latest study of more than 70,000 women took multiple measurements over about 12 years and also used women's own estimates of their weight at ages 18, 35 and 50, to calculate how many years they had been overweight or obese. They then calculated the risk of getting an obesity-related cancer, linked to decades of being overweight or obese.

They found that each decade of overweight was linked to a 7% increased risk of obesity-related cancer. Womb cancer (specifically endometrial cancer; a cancer of the lining of the womb) was most strongly linked to obesity. Both duration and degree of overweight increased cancer risk.

The study has limitations, but suggests that keeping to a healthy weight throughout life may help women to avoid some cancers.

If you are concerned about your weight then try the NHS weight loss plan. This is a 12 week plan designed to help people lose weight in a sustainable way through a combination of healthy eating and exercise.

 

Where did the story come from?

The study was carried out by researchers from nine different universities or research institutions in the US and one in Israel. It was funded by the US National Institutes of Health and the World Cancer Research Fund.

The study was published in the peer-reviewed journal Public Library of Science (PLOS) on an open-access basis, meaning it is free to read online.

The Mail Online's headline saying "Fat women who refuse to diet 'are more likely to get cancer'," is both unhelpful and offensive; straying into the realm of "body shaming". Women who took part in the study received no advice about dieting; let alone actively refused to diet. (The paper version of the headline in the Daily Mail avoids using any offensive language).

Once you get past the unpleasant and misleading headline, with its implications that overweight women are to blame for cancer by "refusing" to diet, the Mail's report is reasonably accurate. However, it repeatedly states that excess weight "feeds" cancers, which is an overly simplistic way of describing the theory that weight may be linked to cancer through its effect on hormone levels, inflammation and damage to DNA. It does not mention that observational studies such as this one cannot prove that overweight causes cancer.

 

What kind of research was this?

The research is a cohort study, looking at what happens to a large group of people over time. Cohort studies are good at assessing links between different factors (in this case duration of overweight and risk of certain cancers) but cannot show that one causes the other.

 

What did the research involve?

Researchers looked at information from a big group of postmenopausal women without cancer, taking part in a long-term cohort study in the US, called the Women's Health Initiative.

They calculated how long they had been either normal weight, overweight or obese, and followed them to see how many of them got one of 10 cancers thought to be linked to weight, over a 12-year period.

Weight was assessed with the widely used body mass index (BMI) measurement, where:

  • 18.5 to 24.9 means you're a healthy weight
  • 25 to 29.9 means you're overweight
  • 30 to 39.9 means you're obese
  • 40 or above means you're severely obese

After adjustment to take account of confounding factors that could affect cancer risk, including age, smoking, physical exercise, diet and whether women took hormone replacement therapy (HRT), they calculated risks of cancers per decade of overweight or obesity.

The researchers used measurements of weight and height taken during the study, and asked the women to remember their measurements at ages 18, 35 and 50. Using this information, they calculated how long the women had been normal weight, overweight or obese during their adult lives. The cancers monitored were:

They also calculated the effect of different degrees of overweight, by looking at the number of units of BMI over the healthy limit of 25 units that women were, for each time period.

This allowed them to compare both time and level of overweight.

 

What were the basic results?

There were 6,301 cancers among the 73,913 women in the study, over 12 years. About two thirds of women were overweight or obese at some point during adulthood. On average, overweight women were overweight for 31 years of their adult lives.

For every 10 years of being overweight, women had a 7% higher chance of being diagnosed with one of the cancers (hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.06 to 1.09). The risk was increased for colon and postmenopausal breast cancers but highest for endometrial cancer and kidney cancer. No link was seen between time spent overweight and rectal, liver, gallbladder, pancreatic, ovarian or thyroid cancer.

When researchers took into account the degree of overweight, the link became stronger, especially for endometrial cancer. Each additional decade spent with a BMI of 35 (10 units of BMI over normal weight) carried a 37% increase in the risk of endometrial cancer (HR 1.37, 95% CI 1.29 to 1.46).

 

How did the researchers interpret the results?

The researchers said they cannot show that time spent overweight causes cancer, but that their findings "suggest that reducing overweight duration in adulthood could reduce cancer risk and that obesity prevention is important from the outset". They said this meant that healthcare services should recognise that "excess body weight in women is important to manage, regardless of the age of the patient."

 

Conclusion

This study adds to evidence that being overweight or obese for long periods of time may increase the risk of certain cancers, just as it increases the risk of cardiovascular disease and diabetes.

The study's size and use of BMI measurements over time mean it is likely to be more reliable than smaller studies, or those that look at BMI only at one time point. The design allows researchers to look at how weight during a lifetime, rather than at one single point in life, may affect cancer risk.

However, there are limitations. It's an observational study, so while researchers took account of known confounding factors such as smoking and exercise, it's always possible some factors were not accounted for. This means the study cannot prove that overweight directly caused cancer. The other main concern is that it relied on women remembering and correctly reporting their weight decades earlier, at ages 18 and 35.

These caveats aside, the study is a serious attempt to quantify the risk that overweight and obesity contribute to cancer risk. Obesity levels have been rising in recent decades and figures from Public Health England show 65% of men and 58% of women in England were overweight or obese in 2014.

The best way to keep to a healthy weight throughout life is to eat a healthy, balanced diet and take plenty of exercise. Some people struggle with their weight more than others, and it can be hard to shift weight once you've put it on.

If you're worried about your weight and want help in reaching a healthy weight, you can talk to your GP for advice or see our information on healthy weight loss.

Links To The Headlines

Fat women who refuse to diet 'are more likely to get cancer': Every decade of obesity increases risk of disease by up to 37%. Mail Online, August 17 2016

Links To Science

Arnold M, Jiang L, Stefanick ML, et al. Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women's Health Initiative: A Longitudinal Study from the United States. PLOS Medicine. Published online August 16 2016

Categories: NHS Choices

Does time of day influence our susceptibility to infection?

Tue, 16/08/2016 - 17:30

"Viruses more dangerous in the morning," BBC News reports, but The Telegraph tells us that "the evening commute is worse for health".

So who's right? It depends if you're talking about mice or humans. What we do know is shift workers may be at added risk of catching a viral infection.

The apparently conflicting headlines were prompted by a UK study that aimed to find out if the time of day contact is made with a virus has an impact on how much and how quickly it spreads.

When mice were given the virus at the start of the day at the beginning of their daily resting phase, it reproduced 10 times more than in mice infected 10 hours into their active phase.

The body clock is said to have an effect on the body's cells. And because viruses make use of our cell activity to spread, the researchers feel viruses may use this to their advantage.

But a point that some of the media seemed to have missed is that mice are nocturnal animals – so their morning, when their body clock "winds down", is equivalent to the evening for humans.

Researchers note that shift workers may be at increased risk of infection as a result of their body clock being disrupted.

Obviously, human cells are not identical to mice and the findings may not be directly applicable to humans.

Still, there may be a case for adding shift workers to the list of vulnerable people who should receive the annual seasonal flu jab.

Where did the story come from?

The study was carried out by researchers from the University of Cambridge.

Funding was provided by the Wellcome Trust, the European Research Council, the European Molecular Biology Organization Young Investigators Programme, the Lister Institute of Preventative Medicine, and the Medical Research Council.

The study was published in the peer-reviewed Proceedings of the National Academy of Sciences (PNAS) journal.

Some sections of the UK media have produced muddled reporting, and the average reader would be forgiven for being very confused.

For example, BBC News reported that "Viruses 'more dangerous in the morning'," while the Daily Mail tries to explain, "Why you're more likely to catch a cold in the morning", but the New Scientist tells us "Herpes infections are worse if contracted at the end of the day".

The apparent root of all this confusion is that there is no mention in the media that we cannot be sure how these findings will transfer to humans.

Mice are nocturnal animals, so the timing of their body clocks is entirely different from those of humans – at least, those who work nine to five.

What kind of research was this?

This study in mice aimed to establish whether the time of day a virus is caught affects the spread.

The researchers hypothesised that the internal body clock, which is constantly switching functions on or off, may have an impact on the spread of a virus. This is because when a virus enters the body, it uses our cells to spread.

While findings from animal studies are useful to see how biological processes may work in humans, our cells are not identical to those in mice.

This means the findings seen in this research may not be directly transferrable to humans.

What did the research involve?

The researchers infected mice with either the influenza or herpes virus at the start of the day, the beginning of their resting phase, or at the start of their active phase, 10 hours into their day.

Two genetically different types of mice were used in the experiment – some with the gene that controls the body clock, and some with it knocked out.

After being given the virus, the mice lived in an environment where they spent 12 hours in daylight and 12 hours in darkness.

After six days, cells from the mice were analysed to assess the amount of virus and the level of spread.

What were the basic results?

When mice were given the virus at the start of the day – when nocturnal animals are starting their daily resting phase – the replication of the virus was 10 times greater than in mice given the virus at the start of their active phase.

When experimenting on mice without the body clock gene, researchers found high levels of the virus regardless of the time of day the mice were infected.

How did the researchers interpret the results?

The researchers concluded that their work has shown viruses exploit the clockwork for their own gain, and the body clock plays a part in controlling the spread of a virus.

Conclusion

This novel animal study aimed to establish whether the time of day when a virus is caught affects its spread.

The findings do seem to suggest – in mice at least – being infected at the start of the resting period led to greater viral replication than being infected during the active part of the day.

The researchers confirmed this by demonstrating that mice without the body clock gene showed a high level of the virus regardless of the time of day they had been infected.

Circadian rhythms are biological cycles in the body related to the time of day. They are sometimes referred to as the body clock, or as the body's individual biological timing.

The body's cells have their own clocks, which interact with each other and are controlled by this master 24-hour clock in the brain.

It is this effect on the cells that the researchers feel is responsible for the differences in viral spread.

These findings may cause concern for those with a disrupted daily pattern, such as shift workers.

Taking a great leap, you could think, for example, that if night shift workers go out to work and catch a virus, they are catching it at the start of their resting period, so it will replicate more. 

But there are a number of cautions to this thinking:

  • Human cells are not identical to those in mice, so we don't know that the findings seen in this research directly apply to humans.
  • Even if the processes are similar, the body clock likely shifts in people who regularly work nights or shift patterns, so their body is geared up to being active at this time.
  • Even if there is greater viral replication, we don't know whether the differences in the extent of the replication are enough to cause greater illness or more debilitating symptoms in the individual.

There are a number of easy steps that can be taken to reduce your risk of catching or spreading a virus.

These include practising good hygiene by always washing your hands, keeping surfaces like keyboards and telephones clean, and, if you have a virus, making sure you use tissues to cover your mouth and nose if you cough or sneeze. 

The case could be made that, especially in the event of a future flu pandemic, shift workers should be added to the list of those thought to be especially vulnerable to the effects of an infection. 

Links To The Headlines

Viruses 'more dangerous in the morning'. BBC News, August 16 2016

Why the evening commute is worse for health than the morning journey. The Daily Telegraph, August 16 2016

Shift workers more susceptible to infections. The Guardian, August 15 2016

Why you're more likely to catch a cold in the morning – especially if you work shifts: Study reveals a disrupted body clock is less able to fight infection. Daily Mail, August 15 2016

Herpes infections are worse if contracted at the end of the day. New Scientist, August 15 2016

Links To Science

Edgar RS, Stangherlin A, Nagy AD, et al. Cell autonomous regulation of herpes and influenza virus infection by the circadian clock. PNAS. Published online August 15 2016

Categories: NHS Choices

UK heart disease and stroke death rates now lower than cancer

Mon, 15/08/2016 - 17:28

"Heart disease deaths now lower than cancer – but obesity crisis means this may not last," the Daily Mirror reports. A major review of European trends in cardiovascular disease deaths found that UK cancer deaths overtook cardiovascular deaths in 2014.

Cardiovascular disease (CVD) is an umbrella term used to refer to conditions that affect the heart or blood vessels, such as coronary heart disease and stroke.

Researchers looked at available data on the health burden of CVD and associated mortality across Europe. It found that CVD is still the most common cause of death across Europe as a whole – accounting for 45% of all deaths. In countries in Eastern Europe, such as Ukraine, CVD remains a significant public health issue.

However in certain Western European countries, including the UK, cancer deaths now overtake CVD deaths.

The statistics from a study such as this can never be 100% accurate. Also, it cannot answer why death rates may be changing – for example whether due to better population lifestyle, earlier diagnoses, or better and earlier treatments; or possibly a combination of all three.

The Mirror is right to strike a note of caution. The current obesity epidemic in the West could lead to an upturn in CVD deaths in the years ahead.

 

Where did the story come from?

The study was carried out by researchers from University of Oxford and Deakin University in Australia, and was funded by the British Heart Foundation.

The study was published in the peer-reviewed European Heart Journal.

While the UK media's reporting was accurate, many of the headlines, such as The Times' "Cancer kills more people than heart disease" could give the impression that this was a global, or at least, Europe-wide trend. In fact this trend was only seen in 10 European countries.

 

What kind of research was this?

This was a review describing the cardiovascular disease (CVD) burden within Europe in 2013.

CVD is reported to be the most common cause of death worldwide. This study is said to be the fourth in a series of papers, giving an updated look at the numbers of people affected by CVD, treatment and mortality burden. The researchers said that "all data included here are updated from previous publications and we present prevalence statistics for the first time". The European Cardiovascular Disease Statistics 2012 report is said to be the source for statistics on disease burden in Europe.

This isn't therefore a systematic review in the formal sense where the researchers have searched literature databases to identify relevant articles. The specific methods by which they identified studies aren't described. 

 

What did the research involve?

The researchers present statistics from a number of data sources, which were said to be chosen with consideration of data quality, coverage of European region, and selecting the most up-to-date. They aimed to get recent data for as many European countries as possible. They gave particular focus to the two common forms of CVD – coronary heart disease and stroke.

There were said to be no "ideal" data sources providing complete, up-to-date, high quality and representative data for all 53 European countries.

Mortality data came from the World Health Organization (WHO) mortality database (up to November 2015), and population size and age distribution was applied to this using the 2013 European Standard Population (ESP); a statistical modelling tool used to estimate mortality and incidence of specific diseases.

Disease prevalence data came from the two-yearly European Social Survey, an ongoing survey looking at social trends.

The WHO's Health Statistics and Information Systems informed on the associated burden of disease. This provides data in terms of disability-adjusted life years (DALYs) – years of healthy, good quality life lost due to the condition. They also looked at the WHO European Region's Health for All Database to gain information on the burden to health services, including hospital admissions, length of stay, and the proportion of people who die within 30 days of admission for heart attack or stroke.

 

What were the basic results?

Total prevalence of CVD across Europe is around 1 in 10 people.

Latest data indicated that CVD causes more than 4 million deaths per year across Europe, accounting for 45% of all deaths – making it the most common cause of death across Europe. Heart disease and stroke accounted for 1.8 and 1 million deaths, respectively.

More than three fifths of all CVD deaths are in over-75s, but twice as many men as women die from CVD before the age of 65. Of countries in the European Union (before 2004), deaths range from – for men – 75/100,000 in France to 481/100,000 in Finland for men and – for women – from 174/100,000 in France to 391/100,000 in Greece. Deaths were generally higher in countries that joined the EU later, such as Malta and Bulgaria, and in countries outside of the EU.

However, CVD mortality rates have been falling by as much as 25 to 50% over the past 10 years. Along with this decline, 12 countries now record more deaths from cancer each year for men, and two countries for women – even though cancer still accounts for less than half the number of CVD across Europe as a whole. This includes the UK which in 2013 recorded 87,511 cancer deaths in men 79,935 CVD deaths in men. Cancer deaths haven't overtaken CVD deaths for women in the UK. The two countries with higher cancer deaths in women were Denmark and Israel (also countries with higher cancer rates in men).

DALYs lost to CVD were highest in Ukraine, with other Eastern European countries also having high rates. The highest hospitalisation rates were in Belarus, with Latvia having the highest associated fatality rate.

 

How did the researchers interpret the results?

The researchers conclude: "Mortality statistics show that CVD remains the most common cause of death in Europe, accounting for 45% of all deaths … More than 4 million people die from CVD across Europe every year, with 1.4 million of these deaths before the age of 75 years. There remains evidence of wide inequalities across Europe in the burden of CVD mortality and the changes in rates of death from these diseases."

 

Conclusion

This valuable research informs on the burden of cardiovascular disease and associated mortality across European countries.

It demonstrates that CVD is still the most common cause of death across Europe, but rates have been falling over the past 10 years. This fall means that in several European countries, including the UK, cancer rates now overtake CVD death rates in men. Generally, CVD disability and burden of disease seems to be greater in Eastern European countries.

The WHO mortality data and population data are quite up-to-date and should be reliable, though as the researchers say, there was a lack of high quality and representative data covering all 53 European countries. Therefore these figures should still be taken as estimates and may not be completely accurate.

Also, this study can only provide statistics – not answer why. CVD mortality rates could be falling due to various reasons – healthier population lifestyles, earlier diagnoses, earlier and more effective treatments – but these are only possibilities, we don't know the exact causes. Similarly with the overtake in cancer mortality, this study doesn't provide data on changes in cancer mortality rates, so we don't know whether these have increased, stayed the same or decreased over the same period.

For any individual, while it's not possible to change genetic factors that may be associated with increased CVD or cancer risk, you may be able to reduce your risk of all of these chronic diseases by following healthy lifestyle recommendations – eating a balance diet, taking regular physical activitynot smoking and limiting your alcohol consumption.  

Links To The Headlines

Heart disease deaths now lower than cancer – but obesity crisis means this may not last. Daily Mirror, August 15 2016

Cancer overtakes heart disease as the leading cause of death: Statins, healthier lifestyles and better treatment saving thousands of lives. Daily Mail, August 15 2016

DEADLY DISEASE Cancer is number one killer of adults in Britain as number of heart disease deaths fall. The Sun, August 15 2016

Cancer kills more people than heart disease. The Times, August 15 2016 (subscription required)

Links To Science

Townsend N, Wilson L, Bhatnagir P, et al. Cardiovascular disease in Europe: epidemiological update 2016. European Heart Journal. Published online August 14 2016

Categories: NHS Choices

Virtual reality helped improve nerve function in paralysed people

Fri, 12/08/2016 - 16:30

"Virtual reality has helped eight paralysed patients regain some feeling in their legs in 'a big surprise'," Sky News reports.

Researchers using virtual reality (VR) combined with a robotic exoskeleton were surprised to find participants regained some nerve function.

The people, eight in total, with paralysis and loss of sensation of both legs (paraplegia), were taking part in the Walk Again Neurorehabilitation programme. Paraplegia is usually caused by a spinal injury so nerve signals from the brain cannot reach the legs.

The programme combined the use of an exoskeleton designed to respond to electrical signals of the brain with VR that provided both visual and haptic stimulation. Haptic refers to the sensation of touch; it is haptic technology that causes smartphone screens to "respond" to your touch.

The technologies were combined to create a simulation of physical activity, such as taking part in a virtual football match.

Researchers expected the training would improve proficiency with using the exoskeleton. They were pleasantly surprised to discover it actually improved real-world nerve function.

All patients showed improvements in their ability to feel sensation and improved their control of key muscles as well as improving in their ability to walk.

The researchers have hypothesised that the virtual activity could help rekindle nerve connections in the spine that have previously lain dormant.

Participants had been paralysed for between 3-15 years. The research team are now planning to use the same technique on people who have only been paralysed for a short time, to see if beneficial effects are more significant.

 

Where did the story come from?

The study was carried out by researchers from a number of institutions, including the Associação Alberto Santos Dumont para Apoio à Pesquisa, University of Munich, Colorado State University and Duke University. Funding for the study was provided by the Brazilian Ministry of Science, Technology and Innovation. The authors declared no conflicts of interest.

The study was published in the peer-reviewed journal Science Reports, on an open-access basis, so it is free to read online.

The UK media reported on these results accurately and included quotes from the study authors expressing their disbelief in what they saw. "In virtually every one of these patients, the brain had erased the notion of having legs. You're paralysed, you're not moving, the legs are not providing feedback signals." said Professor Nicolelis, he went on to say: "By using a brain-machine interface in a virtual environment, we were able to see this concept gradually re-emerging into the brain."

BBC News also hosts a short video of one of the participants, who had previously been paralysed for years, taking some tentative steps on a treadmill.

 

What kind of research was this?

This study is a case report of eight people with paraplegia that aimed to explore to what degree brain-machine interfaces, combined with a VR rig, could help people with spinal cord injuries regain their ability to walk by using a brain-controlled exoskeleton.

Paralysis is loss of the ability to move one or more muscles. It may be associated with loss of feeling and other bodily functions. In this study participants had paraplegia – were paralysed in both legs. There aren't usually any problems with the leg muscles themselves, only somewhere along the course of transmitting sensory or motor nerve signals to or from the spinal cord and brain.

People with paraplegia are usually able to lead a relatively independent and active life, using a wheelchair to carry out their daily activities.

To establish whether this technology would work on a larger scale or on people with different levels of paralysis, further clinical trials would need to take place. 

 

What did the research involve?

The researchers recruited eight people with paraplegia who had chronic spinal cord injury.

Participants wore caps fitted with electrodes to read their brain signals and were asked to imagine moving their arms to create brain activity. Once this was mastered, the participants learnt how to use their own brain signals to control an individual avatar or robotic leg by imagining that they were moving their own legs. They were "connected" to the avatar through the use of a VR headset, that provided images, as well as a number of haptic sensors giving tactile feedback. So it both looked and felt like they were moving their legs.

These signals were read by the electrodes in the cap and used to control to the exoskeleton.

The researchers investigated more complex activities over the course of the study to ensure cardiovascular system stability and patient postural control. This involved various gait training robotic systems.

The six stages of activity were:

  • the patient was seated and their brain activity was recorded using an electroencephalogram (EEG) while they controlled the movements of a human body avatar in the VR environment
  • as above but whilst standing
  • training with body weight support system on a treadmill
  • training with body weight support system on an over ground track
  • training with a brain-controlled robotic body weight support system on a treadmill
  • training using a brain-controlled robotic exoskeleton

Clinical evaluations were carried out on the first day of the trial and then at 4, 7, 10 and 12 months. These evaluations included tests for:

  • level of impairment
  • temperature, vibration, pressure and sensitivity
  • muscle strength
  • trunk control
  • independence
  • pain
  • range of motion
  • quality of life

 

What were the basic results?

The eight participants in the study carried out 2,052 sessions, totalling 1,958 hours. After 12 months of training with robotic devices all patients made neurological improvements in terms of being able to feel pain and touch. 

Patients also improved their control of key muscles and made improvements in their ability to walk. As a result of this study, half of the participants had their level of paraplegia changed from complete to incomplete. 

 

How did the researchers interpret the results?

The researchers conclude: "Overall, the results obtained in our study suggest that [brain-machine interfaces, BMI] applications should be upgraded from merely a new type of assistive technology to help patients regain mobility, through the use of brain-controlled prosthetic devices, to a potentially new neurorehabilitation therapy, capable of inducing partial recovery of key neurological functions.

"Such a clinical potential was not anticipated by original BMI studies. Therefore, the present findings raise the relevance of BMI-based paradigms, regarding their impact on SCI (spinal cord injury) patient rehabilitation. In this context, it would be very interesting to repeat the present study using a population of patients who suffered a SCI just a few months prior to the initiation of BMI training. We intend to pursue this line of inquiry next. Based on our findings, we anticipate that this population may exhibit even better levels of partial neurological recovery through the employment of our BMI protocol."

 

Conclusion

This study reported on the use of brain controlled devices in eight people with paraplegia to establish whether they may be able to regain their ability to walk by using a brain-controlled exoskeleton.

The study found that all patients made neurological improvements in terms of being able to feel pain and touch and had improved their control of key muscles and made improvements in their ability to walk.

These results would appear to chime with the known plasticity of the nervous system and brain. It can continue to change and adapt to different environmental stimulus. So it may be possible that damaged nerve pathways that have been dormant for many years could be rekindled through these types of activities.

However, whilst this technology is exciting and could provide hope for people with spinal cord injury, it is still in the very early stages. These findings are based on just eight people. Many more stages of testing will be needed in people with different causes and severities of paraplegia to confirm whether this does have true potential and who could gain most benefit. For now, it is too soon to know if and when and it could become available.

The cost of VR technology continues to fall, while its sophistication continues to rise. So its use in mainstream rehabilitation at some point in the near future is certainly not in the realms of fantasy.   

Links To The Headlines

Virtual Reality Helps Paralysed Patients Regain Feeling. Sky News, August 11 2016

Brain-robot training triggers improvement in paralysis. BBC News, August 11 2016

Paralysed patients are able to walk again using virtual reality and brain training in 'suprising' [sic] breakthrough. Mail Online, August 11 2016

Virtual reality helps eight paralysed people feel their legs. New Scientist, August 11 2016

Links To Science

Donati ARC, Shokur S, Morya E, et al. Long-Term Training with a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients. Scientific Reports. Published online August 11 2016

Categories: NHS Choices

Gene patterns may explain brain's Alzheimer's vulnerability

Thu, 11/08/2016 - 16:28

"Scientists say they have discovered a possible explanation for how Alzheimer's disease spreads in the brain," The Guardian reports.

Gene patterns in specific areas may explain why the disease tends to start in these regions, before spreading through the brain.

The patterns were found in areas of healthy brains that were primed to produce certain proteins. These were also the areas that tend to succumb first to signs of Alzheimer's disease.

The researchers say this type of gene activity (gene expression) in certain parts of the brain either encourages or discourages the formation of certain types of protein.

Alzheimer's disease is characterised by the build-up of abnormal clumps of proteins, known as plaques and tangles.

The researchers theorise that the body's natural defences become less able to prevent protein build-up as cells age, and this becomes apparent first in the areas most genetically primed for protein overgrowth.

Instead of trying to block all the potential triggers for Alzheimer's disease, they say, future treatments might focus on ways to strengthen these natural defences.

However, all these possibilities lie a long way in the future.

The research may help doctors understand the development of Alzheimer's disease, but much more work needs to be done before this understanding can translate into a safe and effective treatment.

Still, anything concrete we can find about this poorly understood condition is always welcome.

Where did the story come from?

The study was carried out by researchers from Cambridge University and received no specific funding. 

It was published in the peer-reviewed journal, Science Advances.

The Guardian did a good job of explaining the science, and interviewed scientists not linked to the study to help put the results in context.

The Mail Online and The Sun's coverage was also broadly accurate, but neither paper sought out independent commentary on the study.

What kind of research was this?

This was an experimental study comparing data from healthy human brains – which had been mapped for genetic and protein expression – against data about which regions of the brain are affected in early-stage Alzheimer's disease.

What did the research involve?

Researchers used data relating to 500 samples of tissue from the post-mortems of six healthy human brains, all from people aged 24 to 57, none of whom had Alzheimer's disease.

They analysed 19,700 genes to see which affected protein expression in the brain.

They looked at four types of brain cells to compare their levels of genes that protected or promoted protein expression, and the levels of amyloid-beta and tau protein expressed in the cells.

The researchers used the data to "map" regions of the brain that were more susceptible to protein growth because of their levels of protein expression.

They then compared this map to a brain map showing where Alzheimer's disease plaques and tangles typically first appear in the brain using a diagnostic system called Braak staging.

They also looked for other factors that might affect the progress of Alzheimer's disease, such as the functioning of the immune system, measured by levels of genes associated with inflammation in different regions of the brain.

The data came from a database known as the Allen Brain Atlas, which produces 3-D digital images of gene expression in human and animal brains.

What were the basic results?

Researchers found brain nerve cells (neurones) were less likely to express genes protecting against protein build-up, and more likely to express genes promoting protein growth, compared with other brain cells (astrocytes, endothelial cells and microglia).

Neurones were also more likely to be primed to express amyloid-beta protein and tau.

When comparing brain maps, those regions of the brain in which tissues were more susceptible to protein expression correlated well with the brain regions that first show signs of Alzheimer's disease. The two brain maps looked very similar.

The researchers also found healthy brains had higher levels of genes associated with inflammatory responses, but areas of the brain vulnerable to Alzheimer's disease had lower levels of gene expression involved in autoimmune responses.

How did the researchers interpret the results?

The researchers said: "Our results identify a quantitative correlation between the histopathological staging of AD [Alzheimer's disease] and the specific expression patterns of the genes corresponding to the proteins that coaggregate in plaques and tangles.”

They added that the findings related to immune response suggest inflammation is also important, meaning that, "the vulnerability of specific tissues in AD may result from the sum of a number of factors", including genetic control of protein exprssion, natural defences against protein overgrowth, and the response of the immune system.

They said their research shows the brain's vulnerability to Alzheimer's disease "decades before" the age at which the disease begins, and could lead to new treatment approaches, which "rather than trying to prevent a wide range of possible triggering events, could be based on the pharmaceutical enhancement of our natural defence mechanisms". 

Conclusion

This type of exploratory science is needed to fully understand complex diseases such as Alzheimer's, which so far have not responded well to treatment.

The more we know about how a disease begins and develops, the better chance scientists have of finding ways to treat or prevent it.

This research explores one possible contributing factor to Alzheimer's disease. It doesn't provide an early way of telling who will get it – the theory is that everyone has similar regions in their brains that are more vulnerable to protein overgrowth than other regions.

And this is not an easy option for a treatment because we don't yet know how to manipulate gene expression in a way that might prevent protein build-up in vulnerable regions.

In fact, we don't even know whether protein plaques and tangles actually cause Alzheimer's disease, or whether they are just a sign of the disease.

Scientists have been looking for a cure for Alzheimer's disease for a long time. There are many avenues of research being explored throughout the world.

The fact it has taken so long to find an effective treatment is a sign of how complicated Alzheimer's is.

This research goes some way towards explaining the complex conditions that underlie our vulnerability to brain degeneration and Alzheimer's disease in later life. 

Links To The Headlines

New research hints at pattern of Alzheimer's spread in the brain. The Guardian, August 10 2016

Are we another step closer to preventing Alzheimer's? Scientists discover genes that reveal vital clues about how the disease progresses. Mail Online, August 10 2016

Alzheimer's disease researchers discover gene which could help develop preventative treatments. The Sun, August 10 2016

Links To Science

Freer R, Sormanni P, Vecchi G, et al. A protein homeostasis signature in healthy brains recapitulates tissue vulnerability to Alzheimer's disease. Science Advances. Published online August 10 2016

Categories: NHS Choices

Sudden infant death advice 'being ignored' due to flat head worries

Wed, 10/08/2016 - 17:30

"Parents are risking their babies' lives by putting expensive pillows in their cots to stop the back of their heads being flattened," the Daily Mail reports.

A review of parental attitudes found some were ignoring advice about sudden infant death syndrome (SIDS) by letting them sleep with pillows.

Since the 1990s, parents have been advised to put babies to sleep on their backs, in a cot with a flat mattress and no pillows, to avoid SIDS. And this had led, over time, to the lowest number of SIDS deaths (128 in 2014) in England and Wales since records began.

However, about one in five children now develop a flat area on the back of their head (called plagiocephaly) because babies' skulls are soft and still growing. Researchers in Canada and Australia talked to parents, grandparents and healthcare professionals to find out more about attitudes to these issues.

Their interviews showed that the parents were often very worried about plagiocephaly and some said they were "willing to do anything" to prevent it, even if that meant using products that contradict SIDS safe sleeping guidelines.

For most children, flat head syndrome is mild and not particularly noticeable. If you do have pressing concerns then speak to your GP.

While SIDS cases may be at a record low, just one death is one too many. So it is important to stick to safe sleeping advice.  

Where did the story come from?

The study was carried out by researchers from the University of Sydney and the University of Toronto. It's not clear how it was funded. The study was published in the peer-reviewed journal Child: Care, Health and Development.

The Mail reported the study reasonably accurately, although there were a couple of errors. It said that flat head disappears over time "in the vast majority of cases," but the study cites previous research saying that only about a quarter of children had their skull shape return to normal. This study followed babies from age five or six months to 18 months and found that the use of helmets did not significantly improve this rate.

The Mail also cites SIDS advice from Australia, which says babies should not sleep with a blanket. UK advice says blankets tucked under the babies' arms, no higher than the shoulders, are fine.

 

What kind of research was this?

This was a qualitative study, which used focus groups and interviews to identify themes of concern among parents, grandparents and health professionals.

The researchers wanted to explore people's beliefs and worries, rather than to find out (for example) how many parents followed SIDS advice or how many were concerned about flat head. Qualitative studies look at how people experience and feel about subjects, rather than trying to find out factual data.

 

What did the research involve?

The researchers recruited 121 people through leaflets and social media advertisements. The majority (91) were parents, mostly women. They conducted several focus groups and individual interviews, either in person, by phone, Skype or email. They identified themes from the discussions and interviews. They carried out interviews until they stopped identifying new themes or concerns.

The researchers communicated with 91 parents, six grandparents and 24 clinicians, including:

  • four paediatricians
  • two child-care nurses
  • two midwives
  • nine GPs
  • two chiropractors
  • five paediatric physiotherapists.

Focus groups of parents or grandparents were interviewed. Focus groups and interviews used semi-structured questions to find out about people's experiences, with questions based on the existing research into flat head, SIDS and people's experiences of healthcare. They looked at four main themes:

  • the importance of flat head
  • SIDS guidelines and flat head
  • health services for flat head
  • costs to families with a child affected by flat head

 

What were the basic results?

Researchers found that most of the parents knew about flat head, and some of them were very concerned about it. The main concerns were about the effect on the child's looks, with a "round head" being seen as normal and parents worried that children would be teased for having a flat head.

Parents of children with severe flat head, where the condition can affect facial features (such as the positioning of the ears) were most concerned. Some parents were also worried it could affect childhood development or brain growth. (There's not enough evidence at present to know whether that's true).

Some parents expressed frustration or even anger that the SIDS campaign "leads to flat head," and that parents were being "scared" into believing their children would die if they didn't sleep on their backs.

Many of the parents had tried modified pillows sold with the intention of preventing or treating flat head, or had modified the cot by rolling up a towel to tilt the mattress, although these things are against SIDS advice. Others said that the advice to give children "tummy time" where they spent part of the day, supervised by an adult, lying on their stomachs, was too simplistic.

Some of the parents with more severely affected children had taken them for "helmet therapy" where the child is fitted with a helmet that is intended to reshape the child's head. They said the babies found the helmets uncomfortable and hot, and the parents felt self-conscious, guilty and embarrassed about taking them out in public. Research in 2014  showed that helmets don't seem to work any better than waiting to see if the condition improved.

The GPs interviewed said they had little knowledge of the condition and tended to refer patients on to specialists. Specialist paediatric departments and physiotherapy services said they were being "swamped" with referrals, which took them away from seeing children with other "more serious" conditions. 

 

How did the researchers interpret the results?

The researchers said their research showed a "strong caregiver desire to prevent" flat head, and that healthcare professionals who saw children with this condition should remind parents of the SIDS guidelines for safe sleeping, because parents of children with flat heads may be ignoring them.

They added that, given the prevalence of the condition, GPs and others in primary care should be better educated about it, so they didn't have to refer immediately to specialist services. They suggest that group physiotherapy might be a good way to treat the condition efficiently, although there was nothing in their research to back this up.

 

Conclusion

The success of the campaign to reduce the devastating experience of SIDS is not in doubt. Since the Back To Sleep campaign began, numbers of these "cot deaths" have reduced by 65%  in the UK. And, at time of writing, recorded deaths from SIDS are at a record low in England and Wales.

Still, there is no room for complacency. Safe sleeping advice remains important and parents should take it very seriously.

There's no research to show whether cushions or pillows marketed as suitable for preventing flat head are either safe or effective. They are best avoided.

There are some things to bear in mind about the research. It was carried out in Canada and Australia, which have different healthcare systems and may have differing attitudes to health. A survey of UK parents and doctors might have had different results. Also, because the study relied on people volunteering to take part, it's likely that more of the parents who took part were worried about flat head than parents who did not volunteer. This means the level of worry about flat head may be over-stated.

However, as this study shows, many parents are very concerned about flat head. If you are worried about your baby, talk to your GP or health visitor. There are some simple things you can try at home to reduce the amount of time a baby spends with the back of their head on a flat surface:

  • Ensure your baby spends some time lying on its tummy while they are awake, while you watch them, but put them to sleep on their back.
  • Switch the baby between different positions during the day, using a sling or a sloping chair as well as their cot.
  • Move the position of mobiles above the baby's cot, so they move their head to different positions to watch them.
  • Swap over the sides you carry or feed the baby.

Links To The Headlines

Parents who put expensive pillows in their babies' cots to stop the back of their heads being flattened are warned they may be lethal. Daily Mail, August 10 2016

Cot deaths at lowest recorded level in England and Wales. BBC News, August 10 2016

£60 pillows that 'prevent flat head syndrome' are putting babies at risk of cot death, scientists find. The Daily Telegraph, August 10 2016

Links To Science

Martiniuk A, Jacob J, Faruqui N, Yu W. Positional plagiocephaly reduces parental adherence to SIDS Guidelines and inundates the health system. Child : care, health and development. Published online August 9 2016

Categories: NHS Choices

Decline in dog sperm quality 'could be a concern for humans'

Wed, 10/08/2016 - 17:28

"Study showing decline in dog fertility may have human implications," The Guardian reports. The study in question found a decline in the quality of British dogs' sperm since 1988.

The worry is that this is being caused by environmental factors that may also affect human sperm quality and count.

The study aimed to assess changes in sperm quality in dogs over time. Within this, the researchers also looked at whether chemicals in the environment may play a role.

Researchers reported a decline in sperm quality in canines over the 26-year study period, as well as an increase in the incidence of cryptorchidism, the absence of one or both testes from the scrotum.

In humans this is often referred to as having undescended testicles, and has been linked to male infertility and an increased risk of testicular cancer in later life.

The researchers also detected the presence of several environmental chemicals in the canine adult testis and semen.

Media interest revolved around the idea that the decline in dogs' sperm quality is linked to the decline in fertility that has also been observed in men.

But because of the design of this study it's not possible to extrapolate the trends seen in canines to humans.

The study does, however, highlight the potentially detrimental effect of chemicals in the environment on both humans and animals.

Possible risk factors for a low sperm count include smoking, poor diet, excessive alcohol consumption and drug use.

Where did the story come from?

The study was carried out by UK researchers from the University of Nottingham, Nottingham Trent University, the James Hutton Institute, and the Guide Dogs for the Blind Association.

It was funded by the Guide Dogs for the Blind Association and the University of Nottingham.

The study was published in the peer-reviewed journal, Scientific Reports. It is available on an open access basis and is free to read online.

Generally, the media headlines – and, to be fair, our own headline – centred on the notion that declines in dog fertility would have implications in humans.

But the study only looked at trends in canines – the link to humans is merely speculation that requires further research.

What kind of research was this?

This animal study aimed to assess changes in sperm quality in dogs over time. Within this, the researchers looked at whether chemicals in the environment may play a role in the observed trends.

Previous research found the incidence of testicular cancer in dogs has increased in parallel with rates observed in humans.

A similar pattern has been seen with undescended testicles. It has been suggested that this is because dogs and humans share the same environment.

Animal studies like this one are useful research for getting an indication of biological processes and how things may work in humans, but it's important to remember that we aren't identical to animals and findings can't necessarily be extrapolated.

What did the research involve?

Researchers collected semen samples annually over a span of 26 years between 1988 and 2014 from stud dogs bred to help the disabled as part of an assistance dog breeding programme.

The study involved five breeds of dog: Labradors, Border Collies, German Shepherds, Curly Coated Retrievers and Golden Retrievers.

The researchers tested a total of 1,925 ejaculates from 232 different dogs. The samples were assessed for trends in sperm motility, volume (ml), sperm concentration, total sperm output and total number of live sperm.

Ejaculates were assessed from 14 stud dogs to measure chemicals in their sperm, and a decline in sperm quality was observed.

The effects of environmental chemicals on sperm quality (sperm function and viability) were also tested for. And the chemical content in dog food (dry dog biscuit and wet meat) was also measured.

The data was analysed to evaluate changes in sperm quality over time. Confounding effects, such as the age of the dog and body weight, were controlled for.

In addition, the incidence of cryptorchidism in male offspring was evaluated from 1995 to 2014 using records from the National Breeding Centre database.

What were the basic results?

Overall, a decline in sperm quality in canines was observed over the 26-year study period, as well as an increase in the incidence of cryptorchidism in their male offspring during an overlapping timeframe.

A decrease in the percentage of sperm with normal motility was seen at a rate of 2.5% per year from 1988 to 1998.

After the removal of dogs with the poorest semen quality from the study, a further decrease of 1.2% per year was observed from 2007 to 2014.

Alongside this, the percentage of live sperm declined and the output of total sperm increased.

The incidence of cryptorchidism in puppies increased from 1995 to 2014. Over the same period, the number of male puppies born per litter declined.

However, the decrease was no longer observed when postnatal mortalities and stillbirths were excluded from the analysis.

The environmental chemicals polychlorinated bisphenol (PCB) congeners, 5-polybrominated diphenyl ether (PBDE) congeners and diethylhexyl phthalate (DEHP) were detected in the adult testis and semen.

How did the researchers interpret the results?

The researchers concluded that, "This study demonstrates that in a population of stud dogs, sperm motility has declined over a 26-year period.

"Although the mechanism remains to be determined, we have shown that chemicals present in testis and ejaculate directly affect sperm function and viability." 

Conclusion

This animal study aimed to assess changes in sperm quality in dogs over time. Within this, the researchers looked at whether chemicals in the environment may play a role in the observed trends.

The study reported a decline in sperm quality in canines over the 26-year study period, as well as an increase in the incidence of cryptorchidism in the dogs' male offspring during an overlapping timeframe.

The media interest in this study revolves around the idea that the decline in dogs' sperm quality can be linked to the decline in fertility also observed in men.

Further research would need to be conducted in humans to investigate the reasons behind the suspected decline.

The researchers also detected the chemicals PCB congeners, PBDE congeners and DEHP in the canine adult testis and semen.

But although these findings are interesting, the study did not aim to – and is not able to – confirm a link between environmental chemicals and sperm quality.

Professor Allan Pacey, Professor of Andrology at the University of Sheffield, said: "This is an interesting study which suggests that the sperm quality in a population of dogs enrolled in a breeding programme in the UK may have declined over a 26-year period, in a manner which mimics what others have claimed may have happened in the human male over the last century.

"Whilst I am not a strong supporter of the idea that sperm quality in humans has declined significantly – we have changed too much about how we make these measurements to be certain that the decline is real – what is interesting about this study in dogs is that the authors also see an increase in problems of the dogs' testicles (cryptorchidism) and a decline in the number of female dogs born over the study period."

Ways to possibly increase the quality and quantity of your sperm include moderating your alcohol consumption, stopping smoking, staying in good shapeexercising regularly and having a healthy, balanced diet.  

Links To The Headlines

Study showing decline in dog fertility may have human implications. The Guardian, August 9 2016

Quality of dogs' sperm has been declining for three decades: Scientists claim chemicals in the environment are to blame and link it to lower HUMAN fertility. Daily Mail, August 9 2016

Dog sperm quality decline is blamed on pet food chemicals. New Scientist, August 9 2016

Links To Science

Lea RG, Byers AS, Sumner RN, et al. Environmental chemicals impact dog semen quality in vitro and may be associated with a temporal decline in sperm motility and increased cryptorchidism. Scientific Reports. Published online August 9 2016

Categories: NHS Choices

Public Health England: music festivals 'are measles hotspots'

Tue, 09/08/2016 - 16:35

"Music festivals including Glastonbury have become a hotbed of measles this summer, Public Health England has warned," BBC News reports.

The public health body have called on young people to check their vaccination status before attending an event.

Public Health England (PHE) say there have been 38 suspected measles cases reported in people who attended events in June and July.

As there are a number of big musical festivals coming up, such as the Reading Festival, there are concerns that there could be further outbreaks.

What is measles?

Measles is a highly infectious viral illness that can be very unpleasant and sometimes lead to serious complications. 

Anyone can get measles if they haven't been vaccinated or they haven't had it before, although it's most common in young children.

The initial symptoms of measles develop around 10 days after you're infected.

These can include:

  • cold-like symptoms, such as a runny nose, sneezing, and a cough
  • sore, red eyes that may be sensitive to light
  • a high temperature (fever), which may reach around 40C (104F)
  • small greyish-white spots on the inside of the cheeks

A few days later, a red-brown blotchy rash will appear. This usually starts on the head or upper neck, before spreading outwards to the rest of the body.

Isn't measles a thing of the past?

Measles is now uncommon in the UK because of the effectiveness of vaccination. But a plausible hypothesis is that we may see more cases in the coming months because of what can be described as the "Wakefield effect".

In 1998 the now discredited gastroenterologist Andrew Wakefield published a high-profile paper in The Lancet journal.

Wakefield claimed there was a link between the widely used measles, mumps and rubella (MMR) vaccine and autism.

The paper was subsequently found to be based on fraudulent research and was withdrawn by The Lancet.

But because of the controversy the paper stirred in the media, there was a considerable reduction in the number of children who received the MMR vaccine due to parental concern.

These children are now old enough to attend musical festivals – but without the immunity other generations take for granted.

Measles is extremely infectious, and events where people are mixing closely with each other provide the ideal place for the infection to spread.

And measles can be more severe in teenagers and adults, with some of the cases seen recently needing hospital treatment.

What do Public Health England recommend?

Teenagers and young people who are unsure if they have been fully vaccinated should check with their GP and make an appointment to ensure they receive the two doses of MMR vaccine required.

Dr Mary Ramsay, Head of Immunisation at PHE, said: "Measles is a highly infectious viral illness that can be very unpleasant and sometimes lead to serious complications.

"So, if you think you might have measles, please don't go to any of these big events.

"Measles isn't common these days because most of us are vaccinated, but young people who missed their MMR jab as children are vulnerable, especially if gathered in large numbers at an event.

"If you think you've got it, call your GP or NHS 111. Please don't turn up at the surgery or at A&E, as you could infect other patients."

Links To The Headlines

Measles spreading at music festivals. BBC News, August 8 2016

Measles warning to young people at festivals after series of outbreaks. The Guardian, August 8 2016

Spread of measles at summer festivals prompts vaccination plea. ITV News, August 9 2016

Measles spreading at music festivals, health experts warn. NME, August 8 2016

Categories: NHS Choices

Volunteering may boost mental wellbeing in older adults

Tue, 09/08/2016 - 14:30

"Giving up time for charity work found to boost mental wellbeing as people get older," the Mail Online reports. A new UK-based study found that volunteering was associated with increased mental wellbeing; but mainly in adults aged between 40 and 70.

Researchers used data from the British Household Panel Survey, which is an ongoing survey designed to track social and public health trends.

Researchers found that, generally, people's health and mental wellbeing score got worse as they got older. However, when people got over the age of 40-45, while scores generally continued to get worse for those who never volunteered, they got better for those who did any volunteering.

The study's main limitation is that this can't prove cause and effect, or tell the direction of the relationship. People who volunteer may have better health scores because those who feel healthy, active and in a good state of wellbeing are more likely to go out and volunteer to help others than those who feel in poor health. It's not necessarily the case that the reverse is true; that volunteering has caused the good health state.

It could be that the association works both ways – better wellbeing probably makes you more inclined to help others, and helping others probably boosts your sense of wellbeing.

The demand for volunteers remains high and there is always somebody you can help or something you can do to make the world a better place. Read more about options for volunteering, whatever your age.

 

Where did the story come from?

The study was carried out by three researchers from the University of Southampton and University of Birmingham, and was funded by the Economic and Social Research Council, the Office for the Third Sector, and the Barrow Cadbury Trust through the Third Sector Research Centre.

The study was published in the peer-reviewed BMJ Open journal, which as the name suggests, is openly available for access to all.

The media generally takes quite a simplistic view on these findings which do not prove that volunteering boosts wellbeing. The Mail includes messages such as "if you want to get the most out of charity work wait until you are at least 40", "younger people view helping others as a duty and a chore" and "as people get older, volunteering really boosts their mental wellbeing" – not one of which is demonstrated by the findings of this study.

Similarly, The Daily Telegraph reports that "Volunteering is not beneficial until you hit 40, study finds." The implication that you should only do charitable work if you are guaranteed to benefit from it seems a little, well, uncharitable.

 

What kind of research was this?

This was a cohort study based on data collected during the British Household Panel Survey which aimed to see whether volunteering was associated with mental wellbeing among British people across the course of life.

Previous research has suggested that freely giving to benefit another person, group or organisation can boost a person's self-rated health, though most studies have looked at older adults. This study aimed to see whether it affects all age groups.

 

What did the research involve?

The British Household Panel Survey started in 1991, selecting a nationally representative sample of 5,000 households. Those aged 15 or over were interviewed annually until 2008. The study captures 18 waves of data covering various age groups followed up over time.

The survey collected data on various areas of the participants' life, including occupation, education, health, household consumption, and social life. Information on volunteering was collected in alternative years starting from wave 6 (1996). This was assessed by asking if people "do unpaid voluntary work".

Response categories were:

  • at least once a week
  • once a month
  • several times a year
  • once a year or less
  • never

For the purpose of this analysis the researchers combined groups 2 and 3 to give four overall groups – frequent, infrequent, rare or never.

The outcome of interest was the General Health Questionnaire (GHQ) response, which includes 12 questions covering happiness, mental distress (anguish or depression) and well-being to give a total score of between 0 and 36. The lower the GHQ score, the better a person's health is judged to be.

Researchers adjusted for potential confounding factors including income, marital status, educational level and social group.

 

What were the basic results?

After excluding those with missing exposure or outcome data, the researchers had data for 66,343 people (47% male).

Most people (80%) did not do any volunteer work each survey year. About a quarter of those aged 60-74 volunteered compared with 17% in the youngest 15-29 age group. Also, more women (22%) volunteered than men (19.5%).

Those who did any volunteering had slightly better (lower) GHQ scores than those who did none (10.7 vs. 11.4). Scores were lowest among those who frequently volunteered.

When looking at the interaction between volunteering, GHQ score and age, they found that generally, regardless of volunteer status, all people's GHQ score got worse (higher) as they aged. However, when you got above the age of 40-45, scores generally continued to rise for those who never volunteered, but went down again for all those who volunteered – rarely, infrequently or frequently.

How did the researchers interpret the results?

The researchers conclude: "volunteering may be more meaningful for mental well-being at some points of time in the life course".

Conclusion

This research doesn't prove that volunteering will improve your sense of health and wellbeing.

The study does have several strengths in that it is a high quality nationally representative survey that collected regular and comprehensive data for a large number of UK citizens.

However, the main limitation is that it's unable to prove cause and effect, or suggest the direction of the relationship. Those who volunteered had better (lower) GHQ scores than those who didn't – and this was most marked in middle aged to older adults. But this may mean that those who feel healthy, active and in a good state of wellbeing are more likely to go out and volunteer to help others than those who feel in poor health. Not necessarily the reverse, that volunteering has caused the good health state.

The score difference was also marginal – on average 11.4 for those who never volunteered compared with 10.7 for those who did. How much of a meaningful difference this small difference would make to the person's everyday life is not possible to say. These are also of course subjective scores – not confirmed diagnoses of depression. 

When looking at the volunteer work, the survey did not prompt respondents with examples of what might be meant by "unpaid voluntary work". Neither did it look into the types of work they did. Therefore, it isn't certain that this is a reliable estimate of the frequency of volunteering in Britain.

Additionally, while this study has data for more than 66,000 people, this still only represents two-thirds of those taking part in the surveys, the rest had incomplete data. Those with missing data tended to be younger, female, of lower education and occupational level. The researchers say that GHQ scores did not differ between drop-outs and those analysed, but the full data-set may still have had some difference.

The relationship between a person's self-rated health and wellbeing and whether or not they volunteer is likely to be a complex relationship influenced by many other factors and personal characteristics. It most probably works both ways – better wellbeing probably makes you more inclined to help others, and helping others probably boosts your sense of wellbeing.  

Links To The Headlines

Volunteering is not beneficial until you hit 40, study finds. The Daily Telegraph, August 9 2016

Why over 40s are happy to volunteer: Giving up time for charity work found to boost mental wellbeing as people get older. Mail Online, August 9 2016

Links To Science

Tabassum F, Mohan J, Smith P. Association of volunteering with mental well-being: a lifecourse analysis of a national population-based longitudinal study in the UK. BMJ Open. Published online August 8 2016

Categories: NHS Choices

New drug for severe asthma 'shows massive promise'

Mon, 08/08/2016 - 16:30

"Asthma drug 'gamechanger' could revolutionise treatment," The Guardian reports after a new drug called fevipiprant showed promising results in a small study of 61 people with moderate to severe asthma.

Asthma is an autoimmune condition, which means the immune system – the body's defence against infections – malfunctions and attacks healthy tissue. It can cause inflammation of the airways, which can lead to breathing difficulties.

While many people can control the condition with existing drugs, a minority of people only have a partial response to treatment, so their quality of life can be adversely affected.

This trial aimed to investigate whether fevipiprant reduced airway inflammation in people with moderate to severe asthma associated with raised levels of eosinophils, the particular white blood cell linked to asthma.

The 12-week trial compared fevipiprant with placebo in 61 adults. The drug was added to any medication they were already taking.

The main outcome was on the percentage of eosinophils in their sputum, which did decrease by a greater amount in the fevipiprant group. It also had a beneficial effect on quality of life, but no effect on overall asthma control or symptoms.

The potential implications of the research were summed up succinctly by Dr Samantha Walker, Director of Research and Policy at Asthma UK, who said: "This research shows massive promise and should be greeted with cautious optimism."

These initial findings are promising, but more studies will be needed to confirm that the drug is safe and has a definite effect on asthma control compared with other treatments.

Where did the story come from?

The study was carried out by researchers from a variety of institutions, including the University of Leicester and the University of Oxford in the UK, and Novartis in Switzerland.

It was jointly funded by the UK National Institute for Health Research, the EU AirPROM project, and Novartis Pharmaceuticals, the Swiss drug company behind fevipiprant.

Industry funding is not unusual, but four of the researchers were employed by Novartis. This represents a potential conflict of interest that was clearly stated in the study.

The study was published in the peer-reviewed journal, The Lancet – Respiratory Medicine.

This study was widely reported on by the press. While the coverage was generally accurate, much of it was arguably overoptimistic.

Claims that fevipiprant is a "wonder drug" that could mark "the end of the inhaler" verge on hype. Cautious optimism is probably a better approach.

What kind of research was this?

This randomised controlled trial (RCT) aimed to investigate whether fevipiprant (currently unlicensed in the UK) reduced inflammation in patients with moderate to severe eosinophilic asthma.

This is asthma characterised by increased levels of eosinophils – the particular type of white blood cell known to be associated with asthma and allergies. White blood cells are used by the immune system to combat infections.

There are currently 5.4 million individuals receiving asthma treatment in the UK alone, representing a large burden on the NHS.

A double-blind placebo-controlled trial like this one is one of the best ways of investigating the safety and effectiveness of a potential new treatment. However, several stages of testing can be needed before we know whether this could lead to a new licensed treatment

What did the research involve?

The trial was carried out at Glenfield Hospital in Leicester in the UK, and involved 61 patients (mean age 50) with persistent moderate to severe asthma and an increased sputum eosinophil count (more than 2%). Individuals with other serious coexisting conditions were excluded.

Between 2012 and 2013, the participants were randomly assigned (1:1) to receive either fevipiprant tablets or a placebo for 12 weeks. Thirty individuals were given fevipiprant (225mg twice a day) and 31 were given the placebo.

Fevipiprant was added to any medication participants were already taking. The two groups were matched for baseline characteristics.

Patients had a variety of measurements taken at the start of the study, including eosinophil sputum count, scores on the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ), and FEV1, the amount of air that can be forcibly exhaled in the first second of breathing out. Patients were assessed again at weeks 6 and 12.

The main outcome of interest was changes in sputum eosinophil levels between the start and end of treatment. Changes in asthma symptoms and FEV1 were compared, and the safety and tolerability of the drug was also assessed throughout the trial.

What were the basic results?

Fevipiprant gave greater reduction in eosinophil count compared with placebo. In the fevipiprant group, the mean percentage of eosinophils in sputum decreased 4.5 times from 5.4% to 1.1%. It decreased by only 1.3 times in the placebo group from 4.6% to 3.9%.

The difference between groups was statistically significant (3.5 times greater reduction, 95% confidence interval [CI] 1.7 to 7.0).

Looking at other outcomes, fevipiprant had no significant effect on asthma symptoms. In the fevipiprant group, the symptom score decreased by a mean 0.18 points (95% CI -0.54 to 0.18) and in the placebo group it increased by a mean 0.14 points (95% CI -0.22 to 0.49). This made a non-significant 0.32-point reduction with treatment (95% CI -0.78 to 0.14).

The change in quality of life score on the AQLQ was thought significant. In the fevipiprant group, it increased by 0.27 points (95% CI -0.07 to 0.61) between week 0 and week 12, and decreased by 0.33 points (95% CI -0.06 to 0.01) in the placebo group. This was a significant 0.59-point increase with treatment (95% CI 0.16 to 1.03).

Treatment also significantly improved FEV1, with a difference between the groups of a 0.16 litre increase (95% CI 0.03 to 0.30).

Overall, fevipiprant had a favourable safety profile – no deaths or serious adverse events were reported in the group.

Three patients in the fevipiprant group and four in the placebo group withdrew from the study because of asthma complications, but these were not judged to be related to the study drug.

How did the researchers interpret the results?

The researchers concluded that, "Compared with placebo, fevipiprant significantly reduced eosinophilic inflammation in the sputum and bronchial submucosa in patients with persistent moderate to severe asthma and sputum eosinophilia.

"Fevipiprant reduces eosinophilic airway inflammation and is well tolerated in patients." 

Conclusion

This study aimed to investigate whether the new drug fevipiprant reduced inflammation in patients with moderate to severe eosinophilic asthma.

It found the drug had a significant effect on the main outcome being studied – compared with the placebo group, the mean percentage of eosinophils in sputum decreased by a greater percentage in the fevipiprant group.

It also gave improvements in asthma quality of life and FEV1, though the drug didn't have a significant effect on overall asthma control.

Although these findings show potential promise for the future, there are a few points to bear in mind:

  • The trial had a small sample size of 61 patients and only a 12-week testing period. Longer follow-up would be ideal to test whether the drug remained efficient and complication-free in the long-term.
  • The mean age of participants was 50, and the study did not look at the effects in children or young people aged under 25.
  • The researchers only compared the drug with placebo and not other active treatment, though people in both groups continued to take their standard asthma treatments.
  • The main outcome the study was designed to assess was the effect on eosinophil numbers, not asthma symptoms or asthma control. This means it doesn't provide strong evidence at this stage that the treatment wouldn't definitely improve a person's day-to-day symptoms and reduce the risk of asthma attacks.

Dr Samantha Walker, Director of Research and Policy at Asthma UK commented: "More research is needed and we're a long way off seeing a pill for asthma being made available over the pharmacy counter, but it's an exciting development and one which, in the long term, could offer a real alternative to current treatments."

She also noted that this finding should be "greeted with cautious optimism".

Read more about living with asthma. You can also join the HealthUnlocked online forum, where you can connect with other people living with asthma.  

Links To The Headlines

Asthma drug 'gamechanger' could revolutionise treatment. The Guardian, August 6 2016

Asthma pill 'promising' for people with severe symptoms. BBC News, August 6 2016

Could this be the end of the inhaler? 'Game-changing' pill for asthma can cut lung inflammation by 80 per cent. Mail Online, August 5 2016

Asthma pill could prove 'game-changer' for people with severe symptoms. The Independent, August 6 2016

Scientists Hail 'Exciting' New Asthma Drug. Sky News, August 6 2016

First new asthma pill in 20 years hailed as 'wonder drug' by sufferers. The Telegraph, August 5 2016

Scientists welcome 'gamechanging' asthma drug. ITV News, August 6 2016

Links To Science

Gonem S, Berair R, Singapuri A, et al. Fevipiprant, a prostaglandin D2 receptor 2 antagonist, in patients with persistent eosinophilic asthma: a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial. The Lancet – Respiratory Medicine. Published online August 5 2016

Categories: NHS Choices

Claims acupuncture 'staves off dementia' are missing the point

Fri, 05/08/2016 - 16:30

"Acupuncture may help elderly people retain their memory, research suggests," the Daily Mail reports.

But the research the news is based on isn't new; it is in fact a review of previous trials, most of which were judged as being of poor quality.

This was a review that pooled the results of five Chinese studies assessing the effectiveness of acupuncture in treating what is known as mild cognitive impairment (MCI).

MCI describes when people develop problems with thinking and memory which are not severe enough to have a significant impact on daily life. A cause of concern is that around 1 in 10 people with MCI will go on to develop a form of dementia within a year; usually Alzheimer's disease.

The review stated that "acupuncture appears effective [for treating MCI]". However, there are a number of important caveats to consider before taking the statement at face value.

The Chinese studies compared acupuncture as an intervention with a drug called nimodipine. This isn't licensed to treat MCI in the UK (in fact there are currently no licensed treatments). So it's very difficult to draw any comparisons or implications from such findings.

The studies were overall of poor quality with a high risk of bias, covered a relatively small non-Western population, didn't look at dementia outcomes, and didn't provide adequate safety information.

In conclusion, this review doesn't provide evidence that acupuncture is safe for people with MCI or will prevent them developing dementia.  

 

Where did the story come from?

The study was carried out by two researchers from Wuhan University in China. No sources of funding are reported and the authors declare no conflicts of interest.

The study was published in the peer-reviewed medical journal Acupuncture in Medicine.

The Daily Telegraph reported the findings of the study at face value without recognising its many limitations.

The Daily Mail's headline: "Could acupuncture starve off dementia," is incorrect as the study didn't even look at dementia outcomes. But the Mail did include analysis from independent experts, such as Professor Edzard Ernst of the University of Exeter, who said: "This is a perfect example of the 'rubbish in, rubbish out' phenomenon which is well-known to authors of systematic reviews – if the primary studies are flawed, the review of such studies will be flawed as well."

 

What kind of research was this?

This was a systematic review and meta-analysis which aimed to gather the available evidence from randomised controlled trials (RCTs) looking at the effectiveness and safety of acupuncture for treating mild cognitive impairment (MCI). This is a pre-dementia state when people start to have some problems with memory and thinking. It is thought that around 10 to 15% of people with MCI will develop dementia within one year.

There are currently no drugs or treatments licensed to slow the progression of MCI in the UK. Some studies from other countries have suggested that traditional Chinese acupuncture may have a beneficial effect in various brain diseases, including Parkinson's, vascular dementia and Alzheimer's. Some have also studied MCI, which the authors of this review aimed to look at.

A well conducted systematic review is the best way of gathering the available evidence on an intervention, but the pooled findings will only ever be as good as the studies they include.

 

What did the research involve?

The researchers searched several literature databases up to July 2015 to identify randomised, or partially randomised, controlled trials that compared a group who received acupuncture (alone or with other treatment) for MCI with a control group receiving another active treatment. They focused on MCI with predominantly memory loss symptoms (amnestic) rather than thinking problems (non-amnestic).

Studies needed to have looked at cognitive outcomes using at least one validated scale such as the Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), clock drawing task (CDT) or Wechsler memory scale (WMS).

Two reviewers assessed the quality of studies for inclusion and extracted data.

Five trials met eligibility criteria and pooled in meta-analysis. All five studies were published 2012-13, and they all appear to be Chinese.

They include 568 people with MCI, 288 receiving acupuncture and 280 in control groups who all received nimodipine. In two of the trials the acupuncture group also received nimodipine.

In the UK, nimodipine is only licensed for the treatment of neurological problems following subarachnoid haemorrhage (bleeding between the membranes covering the surface of the brain). There has been some research, again mainly in China, looking at the effects of nimodipine in treating MCI as there was speculation it may help improve blood flow in the brain.

The size of the individual studies ranged from 26 to 94 people. In four trials acupuncture was given for eight weeks (three to five times a week), in one trial treatment was for 12 weeks. They used acupuncture points specified in Chinese medicine.

 

What were the basic results?

The three trials comparing acupuncture with nimodipine found that acupuncture was significantly more effective. It improved MMSE scores by an average 0.99 points compared with nimodipine (95% confidence interval (CI) 0.71 to 1.28). Two of the trials also assessed picture recognition scores and found they were also better with acupuncture. Two trials assessed CDT scores – one not giving any results and the other reporting acupuncture didn't help.

The two trials comparing acupuncture plus nimodipine with nimodipine alone also found that the combination improved MMSE scores (average difference 1.09, 95% (CI) 0.29 to 1.89). One reported that it also increased picture recognition.

Adverse effects were reported by three of the studies. Adverse effects of acupuncture included redness at the injection sites and, in one study, fainting.

 

How did the researchers interpret the results?

The researchers conclude: "Acupuncture appears effective for [amnestic] MCI when used as an alternative or adjunctive treatment; however, caution must be exercised given the low methodological quality of included trials. Further, more rigorously designed studies are needed."

 

Conclusion

This review aimed to gather evidence for the safety and effectiveness of acupuncture to treat mild cognitive impairment.

It found some evidence that acupuncture may have some efficacy, but there are many important cautions to this research:

  • All trials compared acupuncture with nimodipine, which is not licensed for this use in the UK. Since there are no treatments or interventions licensed in the UK to prevent progression of MCI, it's hard to draw any comparisons or implications from such findings.
  • There are only five relatively small studies, all of which seem to be Chinese populations. We don't know that study populations or acupuncture practices could be applied to the UK.
  • The trials overall seem to be of poor quality. Only one of the five trials used an acceptable method of randomisation. In the remaining ones it wasn't clear that they were properly randomised. No trials used a placebo/sham acupuncture intervention, and it had to be assumed that both participants and assessors were aware of the treatment that had been given. All of these things may introduce bias.
  • The trials have only assessed changes in cognitive test scores, such as the mental state score. They've not actually looked at progression to diagnosed dementia as an outcome.
  • The duration of acupuncture was 8 to 12 weeks, but we can't say anything from this on how long acupuncture courses would have to be or whether any effects would be sustained after treatment stopped.
  • Side effects were poorly reported by these trials. We don't know that this treatment would be safe.

Overall, this review doesn't provide evidence that acupuncture will prevent people with mild cognitive impairment developing dementia.

There is currently no treatment or intervention available for MCI in the UK, and there is no evidence to say that this is going to change anytime soon. It's not possible to know which people with MCI will progress to dementia.

Nevertheless it is helpful for family, friends, and the person themselves to recognise if they are having problems with thinking and memory as this can help to make sure they get the support they need. 

If you are concerned about someone you know, encouraging them to see their GP is a useful first step. 

Links To The Headlines

Could acupuncture stave off dementia? Needle treatment may help elderly people retain their memory. Daily Mail, August 5 2016

Acupuncture may stop memory loss that precedes dementia. The Daily Telegraph, August 5 2016

Links To Science

Deng M, Wang X. Acupuncture for amnestic mild cognitive impairment: a meta-analysis of randomised controlled trials. Acupuncture in Medicine. Published online August 4 2016

Categories: NHS Choices

Can disruption to your body clock influence back pain symptoms?

Thu, 04/08/2016 - 14:50

"Scientists have discovered that our spinal discs have a 24-hour body clock that can cause … pain when it gets out of sync," the Daily Mail reports; overstating research limited to mice.

While the results may have human implications at some point in the future, the study does not demonstrate the effects of "a good sleep" on back pain in mice, let alone humans.

The researchers took cells from the intervertebral discs found in the spines of mice and people, and tagged them with bioluminescent genes which "pulse" in time with the circadian rhythms that govern the body's 24-hour clock.

They say that cells within the discs had their own "clocks" which were regulated by temperature. When they designed mice without these cellular clocks, their discs became damaged much faster than those of normal mice.

Back pain is a very common condition, likely to affect as many as 8 in 10 people. Damage to intervertebral discs – the cushions of fluid and cartilage that separate the bones of the spine – is thought to be a major cause of back pain. The researchers say that these discs thin out during the day, with the weight of our bodies, then expand again at night when we rest, with fluids regenerating the tissue.

The researchers said in a press release that getting a good night's sleep "will protect our body clocks and potentially avoid disc problems later in life." However, there's nothing in their study to prove that this is the case.
 

Where did the story come from?

The study was carried out by researchers from the University of Manchester and was funded by grants from organisations including the Medical Research Council, Arthritis Research UK and the Wellcome Trust.

The study was published in the peer-reviewed journal Annals of Rheumatic Diseases on an open-access basis, meaning it is free to read online.

The study was accompanied by a press release that made a number of optimistic speculations, such as "Based on our findings, we hope that one day, we may be able to combine NSAIDs with clock targeting compounds to provide a more powerful solution [to back pain]."

The Mail's headline took the press release one step further, suggesting that back pain can be beaten by a good night's sleep. While sleep is undoubtedly beneficial, back or other types of pain can prevent you from sleeping well, so this may not be a helpful message for sufferers. Further into the story, the Mail reported speculation from the study authors about the implications of their research for future treatment of back pain, and the possible effects of shift work on circadian rhythms.

 

What kind of research was this?

This was an experimental animal study, using mice bred for the purpose in a laboratory. Cells taken from human intervertebral discs were also used for one experiment, although we don't know where they came from (ie whether they'd been removed from people suffering back pain). The researchers wanted to look at the molecular and genetic activity within cells, to understand how circadian rhythms affected intervertebral discs.

These types of studies are useful to aid understanding of the basic science behind a disease. They're not tests of treatment for disease. Also, the results of animal studies don't always translate directly into humans.

 

What did the research involve?

Researchers carried out a number of experiments using cells taken from the intervertebral discs of mice and people. The experiments were designed to show whether cells had their own 24-hour clocks and how they were affected by external factors such as age, temperature and inflammatory chemicals.

In a separate experiment, live mice were bred without 24-hour clocks in their intervertebral disc cells, and were monitored for disc degeneration, compared to normal mice of the same age.

Researchers made the cells luminescent so they could track the activity within them, in line with daily rhythms. They stored the cells in containers where the temperature changed slightly at different times, to monitor their response to temperature.

They used two types of chemicals associated with inflammation – interleukin B and Tumor Necrosis Factor – to assess how these affected the 24 hour clocks. They compared the clocks' activity in cells from older and younger mice.

In the second experiment, they looked at the condition of discs of mice without 24-hour clocks in their disc cells after six months and 12 months, compared to normal mice.

 

What were the basic results?

The researchers say they showed that both mice and human disc cells had their own internal 24-hour clocks, demonstrated by their regular emission of pulses of light.

The cells became desynchronised when subjected to temperature changes at different times, suggesting that body temperature may be what "sets" the cells' clocks. Cells from older mice had a weaker 24-hour pattern than those from younger mice, reflecting the way that body clocks are known to weaken with age. The cells' body clocks were disrupted by interleukin B, suggesting that long-term inflammation could also cause body clock problems.

The discs of engineered mice without body clocks in these cells degenerated much faster than those of normal mice. Images of the discs after 12 months showed they were much thinner, had bony growths into the cartilage and signs of fibrosis in the tissue around the edges.

 

How did the researchers interpret the results?

In their paper, the researchers were fairly cautious, saying their results "support the notion that disruptions to circadian rhythms during ageing or in shift workers may be a contributing factor for the increased susceptibility to degenerative IVD (intervertebral disc) diseases and low back pain".

However, they went further in their press release, advising people to avoid night working and work regular hours. Of course, not everyone has the luxury of choosing what hours they work.

 

Conclusion

Back pain is a major problem for many people. Keeping active and taking painkillers when required can help, but some people find it significantly disrupts their lives. Knowing more about the causes of back pain may help doctors to find new ways to combat it, or even prevent it.

Experiments using cells and laboratory animals can help scientists to understand what affects the course of a disease at a cellular level. This may be of use in future to develop treatments. But until that work has been done, this study doesn't tell us what will actually help back pain sufferers.

We already know that shift work is linked to many chronic diseases, and that back pain seems more common among people who work night shifts. This research may help explain whether shift work contributes to back pain, but it doesn't prove that it's the cause. It's not necessarily helpful to tell people to avoid shift work to protect their spine – for some people, there is no alternative.

Getting a good night's sleep is good for health, whether it affects back pain or not. If you are having trouble sleeping, take a look at our information on how to sleep well.

Links To The Headlines

A good sleep can beat back pain – thanks to the 24-hour clock in the spine: Discs can cause agony if they get out of sync. Daily Mail, August 4 2016

Links To Science

Dudek M, Yang N, Ruckshanthi JPD, et al. The intervertebral disc contains intrinsic circadian clocks that are regulated by age and cytokines and linked to degeneration. Annals of the Rheumatic Diseases. Published online August 3 2016

Categories: NHS Choices

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